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f t *r <br /> C�ty Of �DrOno <br /> Building Permit Application for IV��inten�nce I I�.enovation <br /> windows, d�or� �9�iinr� rewrts�f .�t�. <br /> � , "-� ' ''�� <br /> Maili»g�ddt�s9t �'�trnit nUmber; � <br /> P�i�Qx 6� � -� <br /> ����� Cryst�i E�ay,MN 5���3�066 i��t�r received: � —, <br /> i�e�eived by: <br /> ��n�er Ad�r���: <br /> � ; ` � 2750 Keii�y Parkw�y PI�t1 fevleW'Pee: <br /> ���� �'� �ronv. MN��356 <br /> �"ot�i Fee; � � ��a�-� � � <br /> M�in: 852-a49-4600 �ax; 95�-��9-4fi'16 r • <br /> 7his application form must be complmted in fwil and alE r�qulred In�arrt�atlort must be swbm9tted. Y� <br /> Incomplete applications will b� returned. (Pr�ase print} y� �C I <br /> CaENERAL IN�'ORMATION: r� :'" • • `� <br /> .lob Site Acidress: � �4�� � °��`J Nn <br /> Yes <br /> Will Chls b�a Parade of Womes,Remodeler�5�c�wcasa W�me ar oth�r blsp y y Ho�hQ e�,�ent. shurr/e 4us servrce w111 be <br /> 1f ys9,a specla/event permrY Is reqUired wlth Polrce l�epartment anrl Cr#y Counci!�pProv�!60 da s p <br /> requir'ed unless appliCBnt demonstrates 8v�17cfent on�ite parking�s availab�e. Non-p9mriftcd evente w!!1 not be ailowsd. <br /> CON?'RAGTQR/APPLiCANT INFORMAT10�1: <br /> �a"��: �`C' ���K�� �xpiratian Date: 3 (3 <br /> �tste Licensa# G�30� <br /> SU T� c��� Explratian Date: �j <br /> L.ead Certificatlon Numher. _ $3 -' l — <br /> (for wvrk on homes thaf were consb'ucioedprlor.fo 1878 `��) (cell) <br /> Phone: �5�~ o�� " d�- zIP: � <br /> Mailing Address: tiQ 1 •'G•, � �����'��' �' <br /> C�ntact Person: Appticant ls: ntr� r / Homeowner cc�rose o�a� <br /> Emaii and/or Fax: <br /> PROPERTY OWNER iN�O�;AT10N: t� @ <br /> Natt�e; <br /> �hvn�(day): �� �. . �- ' �lP: <br /> ,�dress: - ��tY_. <br /> �mai!and/or Fax <br /> pE20J�CT 1NFaRMA71�N: - p,ny ed�{�,ma�ment m�y requiro <br /> *ype of ProJect: MCWD review 8�p�rmlts: <br /> �QDDf��� � ❑ Remodel (��lrA�amag� �y���s�g�a 6ra�k Watershed Distrfct(MCWD) <br /> �� �i� ��to��g��g� 18�tl2 Minna�onka�Ivd <br /> (� E��ro�t,asphglt � - W t����I�aven, MN 553�i <br /> [,� (��-roof,cedar �I��stargti�it �W�t�P���1�c�� �hone: 952Y4'�1�059Q <br /> (�QtNer:(�psc . Fex: 85�a47�-0582 <br /> �F��-tbt�f,ot�ter(spectiy} �Sidin� �� ,,,,��inr�ettaha�rsek>orq � <br /> [�Window(s) - _ <br /> _ _ � �. - ..r`o_ � .��, _� ���� o <br /> [aver�ll �raject Descrl�t�on: ; �. a, <br /> v <br /> �stimat�d Canstruction V�luation of Wraj+�ct(�x�ludin iand � <br /> APPt�1CAN7 ACKNOW�.EDGEMENT: <br /> . Agrees to provlde all information required or requ9sted by the 6uilding C�epsrtm8nt; <br /> • Geftifles th8t fhe information supplied i6 tfve �nd�orCSCt tb fhe bsst o�hl6/her knOwledgA, 'Th� appll�nt recognlx�s ihat thBy <br /> are solery rgsponsible for submitting a cornplets applic�tion being aware fnat upan fai(ure tn do so,the staff has na altemative <br /> but to reject�t untif it is complete; <br /> • Some or a1i oi the ;nformatian that yau are asked to provide on this appiicatlon is classified by State law as either private or <br /> conl5dentiaL F'rivate data is Infarmatlon Whlch generally �annot be given to the publiC bUt C8n be given to the subjeaf vf the <br /> data. Confldential data is infnrsn�kton which g�nerally cannot b� giV�n to aither th� pub}ic or the subj�t of the dat2_ Our <br /> purpose and Intanded use of this information is to annu8lfy upd�te our recoCds end recotdS of other goVBrnmenia! agencles <br /> re ulred b law. ff ou refuse to su 1 the inform tlon the a If tlon mS n t be fssue�. <br /> j-� �,l,ti.�'�'��"�.--� �ate: t������' <br /> Anolicant's Sionature: �1, <br />