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.b'��1,_� ��`'`` � <br /> .� <br /> "City of Orano <br /> Building Permit Application for Internal Work <br /> windows, doors, sldin , re-roof, etc. <br /> �.Oj� . �oe�ox� <br /> O O ���Y�MN 38323-0066 <br /> � � Str•et Addras�� <br /> 2750 Kell�ey PsAtway <br /> � Ofdto,MN 55356 <br /> Meln: 952-249-4600 Fax: 952-249-4616 www. I. ron . <br /> Thls applica�on form must be oompleted fn full and atl requlred fnformatlon must be submitted. <br /> Incamplete�pplica�ions wlll bo'returned_ (Ple�ase pr�nt) <br /> GENERAL INFORMATION: <br /> Job Site Address: . � <br /> Wiil this be e Parade of Homes, Remodelers 3howcase Home or other Display Home? Yes No <br /> NY�a�e apecle/everd permh la reqWaad whA l�hoe Oapa�hnenA and c�ly Counc�/ap�ve/60 ders pAor w tl►a sr�i Shutlle bus ae►Wtre w�!be <br /> iaqWreo uMass BpplM�l dem�onahatea aullklaM a�lts paAong ia evade6le_ Nfon-ponnitfed everda wNl rrot be e�bw�ed. <br /> CONTRACTOR I PLICANT II�F RMA QN: t' � <br /> Name: (�h h 1`101�1, � <br /> Stste Lloense# E�ira�on Da�e: <br /> Phone: - of'Hce cell <br /> Meiling Address: CI . zIP: <br /> Caitad Person: ApPl�nt is: Contracbor / Homeowner �c:s.�.o�e) <br /> Email and/or Fax: (�a- 5''�?���e/� <br /> _ _ -- <br /> PROPERTY ONM I ORM TI : <br /> Name: � ti <br /> Phone(day): • <br /> add�ss: c� . ziP: 5535 Co <br /> Email and/or Fax� <br /> PROJECT INFORMATION: <br /> 7'Ype ot sct: , <br /> Arfy emi�th movarr�nt�ner requin <br /> ❑��(g) ❑Remodel MCWO revlew 8�pennita <br /> �,0 W�er Damege ; <br /> ❑���Kg) ❑RePa� ❑Storm Da Minnehaha Creek Watershed Dishict(MCwD) <br /> mage 18202 Minnetonka Blvd <br /> 0 3tdbt9 ❑Resbratlon Deephaven,MN 56391 <br /> ❑�Ufer.(spsdfY) Phone: 852�71-0590 <br /> ❑Flre Damepe Fam�932-471-0682 <br /> O1/BfB��p t�eSCI; (Of1I �� w <br /> Estimated Constntction Valuatibn of Pro eet excludi land s p bo p, � <br /> APPLtCANT ACKNOWLEDQEMENT: <br /> • AOrees to pmvide aA Mtorma�o�required or requested by qte Bullding DspartrnenK <br /> • Certlfles Ihat d�e infortnetlal;supplied ib bue arld Carnect to Ihe best of hi6lher knawledge. The applipini recognFres ttrdt they <br /> are solely reaponeible for submltqng a complete applNatfon being aware fhst upon iailure to do ac, the sfaf�h�no allemelNie <br /> but to reject it u�b�It Is complete; • <br /> • Some or all M tl�e inFortnati�n thet you are asked to povide on thls a�p8cation ts daesMed by Stato Iaw ss�tlier privata a <br /> confldential. Private data is�IMamslian which generally c�ruwt b�phren bo tl�o public but can be ghren Eo Ihe sub�ed of the <br /> data. ConAdentlal data is Mfonnatlon whi� generally amnd be'giv�en 10 either Ihe pubNc �t�e subjed ot the date. Our <br /> D��P�e and (Mer�ed use of�Is Iniormatio� is to annuaqy upda�e our records and r�eoorda of other govemmental a9endes <br /> uired 18w. if re�use to su q�e li�on,q�e r�t��u�. <br /> Appllcant's Signature: � l �1 � <br /> Dste: C' <br /> t.�u�d: o�.oe,� <br />