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..�r� � 10/MON 04: 17 PM P. 002 <br /> � � '�� <br /> , io( <br /> City of Orono . ; <br /> Building Permifi Appl�cation. for �n�ernal Work , . <br /> (windows, doors, siding, re�roof, etc_) <br /> MailingAddress: Permlt number: �a��7� <br /> O.g,O,�Q PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received' �% l0 <br /> � ,, StreetAddress: Received•by: <br /> �,� � �! �tiF 2750 Kelley Parkway � Plan revlewfee: <br /> �`�k�sxo,i,,�• • Orona, MN 55�56 � ��� ,� <br /> Total�ee: <br /> Mdlll: 952�Z49-4600 Fex: 952-249-4616 www.ci.orono.mn.Sl� <br /> This applicaiion form must be compivtcd in fuil and all rcquir�d information must be�sulamitted.' . , <br /> � , • • � lncomplete applications w1li be returned. (P/ease prinfJ , <br /> GENERAI� INFORMATION: � / y� A � � , � . . <br /> ....J_o,�b.-�rlie_F�;s�l���_ ... ..._..7 GZQ_5-/V_l-/-! f�1(`�l_/�-1.lG--r V � <br /> ...._........_._..... .._.._...._. <br /> Wfll th►s be a Parade of Nomes, Remodelers Showcase Home or other D1�play Home? Yes � No <br /> /f yes, e spBcla/event permitls requ/red with Police D�parlment and Clty Council epprove/60 days prior to the event. Shutt/e bus servlcs w/l/be <br /> rcqulred un/eRR appllcant derrronstrakes SufflClent On-si�e peiklnp 15 aVellab/e. Non-pe1'm/lfed evenfs w!!!nOf 6e ellowed. . . <br /> CQNTRACTOR/APPLICANT INFORMATION: � � � . <br /> Name: � . <br /> 5tate License# Pella W'indows &Doors <br /> Phone: ., --15300 2�th ,Ave�T. Ste 100 (ceIIL <br /> Mailing Address: . p�y���.outh,�I�T�55447 ziP: <br /> Contact Person� Z,ic�#20165884 Pl�. 763!745-1�100 °meowner ������o��� <br /> Email and/or Fax; nd` dD �/�tI' ,� /�,�5 <br /> 4s� ��34s •4ay7 <br /> PR�PERTY OWNER IN�ORMATION: � � � <br /> � Name: � <br /> Phone(day): L I ? a - 7 6 � <br /> Address: �T o o 'S t r F �S �v�t c�ty: �l'�S� Z�e� �'e z�P: S S 3 9 ./ <br /> 7 . <br /> Email and/or Fax <br /> PROJ�CT 1NFORMATION: <br /> Type of PfoJeCt: � Any Qarth movement may raquire � <br /> . MCWD revlew& Dermits <br /> ❑ Door(s) ❑ Remodel ❑Wat�r Dam�pe <br /> Minnehaha Cresk Watershed DistrlCt(MCWD) <br /> Window(s) �Repelr ' (] Storm Damage 182D2 Mlnnetonka alvd� � <br /> Deephaven, M N 55391 <br /> p Siding ❑Rest01'ation ❑Other:(apecl'Fy) • Phone: 952�471-0580 � <br /> Fax� 952-a71-06B2 <br /> 0 Ra-roof ❑Fire Damage •� www.minnehah k.or <br /> Ovefall Pr�ject Description: 3 w,n C(v W- /'` � G J�I t / � l•� 0 I �' <br /> Estlmated Construction.Vafuation of Project (exclu ��g land) $ (, '] � '� � , . . <br /> APPLICANT ACKNOWLEpGEMENT: � <br /> • Agr�:es to pfovide afl info�matlon r�quired of requested by Lhe Bullding Department; • ' • <br /> • Certifies 4hat the informatlon supplied IS true and correet to the best of his/her knowledge. The appllCant recognizes that they <br /> " are solely responsible for submltting a complete application being aw2re that upon fallure to ao so, the staff Ytas no altemative <br /> but to reject it until it Is Complate; <br /> . 'some or a1l of the Information that you are asked to provide on this appllcatlon is classified by State law as elther private or <br /> Confidentlal. Prlvate data IS Infofmation whiCh generally CannOt be given to the publfc but can be glven to the subject of the <br /> data. Confidential data is informatfon which generally cannot be glven to eltner the publle or tYte subject of the data. our . <br /> purpose and intended use of this irtformation is to annuafly update our records and records of other governmental ageneies <br /> fequiretl b law. If ou refuse to euppl thc Infotmstion the a IlGatipn ma not be issuQd.'• <br /> ApplicanYs Signature: pate: r� j Y ` � � <br /> ated: S-Oa-2009 � <br /> �a9t u� o <br />