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Au� 03 ;� 12: �p HAMEL LUMBER 7634786284 p.1 <br /> y <br /> - D�/ ��/ <br /> C�ty of Orono <br /> ; Building Perm�t Application #or Ir�ternal Work <br /> �windows, doors,'sitiin , re-raaf� etc.) <br /> - Mailing Addr�ess: <br /> Q � P Permit numF�er, vZ0/O— D !P <br /> O Box 66 <br /> /� � Crystal Bay, MN 55323-0066 Date received: $ � /d <br /> ! <br /> •� �r Str�et Addness: � Received by: �(,�_ <br /> � • �/r 2750 Kellsy Parkway � <br /> � MIV 55356 f�!an review fee: <br /> Orono, � <br /> Tota�Fee: ��,�`j—d <br /> ain: �52-249-4600 Faz: 952 249-4616 �iNv�v.ci.cr�no.,�i�.us <br /> ; his application form must be compieted in full and aN required information must be submltted, <br /> Incomplete applicatfotu will be retumed. (P/ease print� <br /> GEN ' L FORMATION: <br /> ,�oa s t�a �ss: .�o s'� S°'�ss��c ,�'o• <br /> Wil( t s be Parade of Homes, Remodelers Sho�rvucase H�me or other Display Home? Yes o <br /> 1/ ,ja sp 'al eventDennlf ia rs9u�rad wltl►Fb►ke Depettment enrl C�ty Councl!appmve160 daJs pdorl+c 1he avent ShuMla b�s se,rvlce Lvld be <br /> uired unless qpp6csnt demonshetes sulfncient on�if�e peNrfng�a e►raila6fe. Non�ermlttear eventa wNl not be a�bwtid. <br /> C�IV C R d AFPLICANT lNFQRMATION: <br /> Narr� .�v-r�F� /�o-i�,o��,G L',�-v1'a��Z. <br /> State id�e # �063/� a �xptraBon Dete: � . ��y <br /> Phan : 76� Y�� — G�v � office 6f� �yG --�s'a GeII <br /> Maili g jAd ss: 1�'7�D ��✓� ss City" piy�•+�Yr�' ZIP• ts�y� <br /> Cont Pe n: ,r.,�.�r �, 1�c<�,y�Gtiy Appticant is; � a ar Hvrrteowner (Cir�l�One► <br /> v <br /> Emai a J Fax: �'trcc e'.�sis�rici�iv�.r�,.....�.aso-.�o.�c��r�+s2 ,cr�,-.,-_ �76?� y7� ��y <br /> FRO � OWNER�NFORMATION: <br /> Nam :; �/sf�,¢G�f �'�vSS <br /> Pho e i(da G�.z Y8-� /��� <br /> Add as: �osa Sr.ss�c ��o, Cilv- G�� ZIP� SS3s6 <br /> Em I�nd r Fax <br /> PR EC �NFORMA714N: <br /> TY af P • Amr earth movement�ay r+equire <br /> MCWD roview 8 psmnits <br /> o4�(s) �in�� ❑ Rernode� �Water Damage <br /> �Minnehahs Creek Watershed District(MCIAID) <br /> p itpdo ) p Repair p S'�orm Demage 18202 Minnetonka Blvd <br /> ❑ iding ❑Resloration ' ` t �P�Bn,MN 55391 • <br /> ❑a�er. (specif�); Phone: 952-471-0590 <br /> ❑ ei-roo ❑Fire Dartta e Fax: 952-471-0662 <br /> 9 ��•rvr+i..�,�rn��i�a hacr�nk.�r:� <br /> O il ect Descri tion: .e�,r.�s�' r��'yi.►�r.-: � S'./�r•�G d1,�ss �vP.,� —s.�,f,f Si �'a �•�.-v� <br /> Es mat Constructlon llafualion of Pro ect excludin land $ : ' /tp, a.�, <br /> A PLI NT ACKNOWLEDGEMENT: <br /> •' rees to provide all informaiion required�r requested by the Building Departmeni; <br /> � rtiFies that�he information supplied is true and aorred to the besi of hiaTher knowledge. The applicent reCognizes that they ' <br /> e solaly reaponalble for subrnitting a complete application being aware that vpon failure to do sp, the staff has no eftemative <br /> t ta reje�t it un4'rl it is carnplete; • <br /> � me or all of!he iniarmetion thst you are aslced W provide on this applic��ion is classified by State Isw as either private or <br /> nfideMial. Private data is infnrmation which generally cannat be given to the pubtle but can be given to the subjecl af the <br /> fa Confldential data is informetlon which genera6y Cannof be given tn either the public or th0 subject of the date. Our <br /> urpose and intended use of this infortnation is to ann�ally update our recsrds and records of other govemmentai agencies <br /> uired b raw. It �retuse to su i tfie Info►maUon the a lication ma no4 be issued. <br /> � <br /> pli 's Sfgriature: � ��.�----� Date: c��3�o <br /> - �—' <br /> � <br /> sp!Jp ed: 08-64-2008 � ' <br /> � <br />