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10 17:07 From:Window World 6517706495 To:9522494616 Pase:2�3 <br /> � � City of �rono <br /> Buiiding Permit Application fo� internal Work <br /> (windows, doars, sidi� , re�, etc. <br /> Ma�ling Addies.� Pertnit number. a!' 6—d�� g <br /> ��O�0 Crystal Bay, MN 56323�066 f�iaceived: / O <br /> � � SbaetAddisss: Receiv�ad by: <br /> 2750 Kelley ParkwaY PJ�n review tee: <br /> Orono,MN 55356 <br /> Total Fee: ,ll D� ��j' <br /> M;�in: 962-248�6W Fax: 952-249-4616 N�a orarto.mn�a <br /> This applfcstion form must be comple , iull and all reqi�ired infonnation mu�t be submifSed. <br /> McamPlete aPPl�ti�wfU be eatumed. (Pk�ase Piint) <br /> QENERAL INFORMATION: <br /> Job Site Addr.e.$s; 2100 Count Rd 6 <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> �ryes,a sneow erer,r v���Wred��o�rnr,�+t�r,d ary c;o�nar a�ro►�er eo ceys�ro n,e e� snva�s a,s se�v;oe w�r ne <br /> �q„irgd Unless�pNe�►r darria�rslas�enr w►,s�"tepa►br�g;s� lyon�pernf��ewerus wa�noe be sl�owea. <br /> CONTRACTOR/APPIICANT INFORMATION: <br /> Name: ProBuilt America <br /> State License# E�iratbn Da4e: <br /> Phone: - ' (off+ce) (celD <br /> M�ilingAddress: �ii iifh�ve ��y: . �" aF—uI Z�p: „ <br /> CoMad Petson: ��" ApplicaM is: Co�raetot / Homeowne�' �a�a.a�e� <br /> Emailac�lo�F�c: estherd�wiadowwor .com-651,-770-0495 <br /> PROPERTY OWNER INFORMATION: <br /> Name: Orono Odovdlaada <br /> Phone(day): <br /> Add�ess: same as si e ; CitYy: ZIP: <br /> Emaii and/or Fax <br /> PROJFCT INFORMATION: <br /> 'rype of P�vj.ct: Any e�Ah moven�eM may require <br /> MCVYO review b pennits <br /> ❑Door(s) ❑Remodel ❑Water Damage <br /> Nfmnehaha Creelc 1Afa�er�ed DistriQ(MCVVD) <br /> f8 vuindaw(af D� ❑Smmn Dam�e 18202 Minrtemnka Blvd <br /> Deephaven,MN 55391 <br /> ❑Sidirg ❑Restora6on ❑Other.(9pecify) Phone: 952�t1-0590 <br /> F�c: 862�71-0682 <br /> ❑Re-►oof ❑Fre Dsmage vM�uv m�n�ehahacr�ek o�u <br /> Ov�erallProjedDesc�iption: Replacing 12 windowe not changing_ size_ <br /> Estfinwbed Construcdon Valuattoo of Project(excladin�land� i 3 0 96 <br /> APPUCANT ACKNOWLEOGEMEN7: <br /> • Aprees b pcavide aU inUoim�roQuired or eaQue�d b�the 6uildic�8 QspaM�onfi <br /> � Certi�es fFa�i the iniomiation supplted is 6ve and correct b the bast of h�/lter Imawla�e. Ttee�ppli�rd r�oogn'v:as th�t lhey <br /> ane aelely�ponsible fo�submitling a oomplste applicatlon bsing aware that upon isaure to do so,the staft has no altemalfve <br /> but to re)ed it uMil it is corrtpis�s; <br /> • Some or all of the mfv�ma�on that you sre asl�eed tp provide on this applicabvn is d�ssifiad try State law as eitlt�pmrats w <br /> aonii�dentlal. Prhre�e deta is iMonnation whiah generatly cannat be yiven to the public but oan be ghren to the subjed of the <br /> dsta. Cor�ntial data is in�nnatinn wtu� generapy cannot De given te ehAer tAe �blic�r the su�jec�of thg dals. Our <br /> purpose and iMsnded use of ihis inlormabon is to annualy update our rec�ds an4 rec�ds of other govetnnzental �qer�g6 <br /> lavl►. If u fe(1t9e t�Su the intonnati0o I�e ' .on fna rlot bE is�ted. <br /> ��. - r�.�- oe�2?��0 <br /> Apa�icanes Signah,re: oa�e: <br /> �e uaaae�e: o5-o�v-2oo9 <br />