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Aug-25-2011 07:13am From-CITY OF ORONO +9522494616 T-146 P 002/002 F-396 Building Permit Application for Internal Work windows, doors, siding, re-roof, etc. 0" MahiPO so 68 Permit number o?o Q Q Crystal Bay,MN 55323-0068 Date received: z Street Address: Received by: 2760 Kelley Parkway p Orono. MN 553513 lan reNiew fes: Main: 952-2494800 Fax: 952.249.4618 Total Fee: / ��' p� Jm This application form must be completed In full and all required information must be submitted. GENERAL,INFORMATION: Ineomph"applications will be returned. (Please pNno Job$its Address: rj 5. W1, Havol, b(a64.4, Will this be a Parade of Homes, Re modelers Showcase Home or other Display Flame? U Yes No K rift a spo w event pe"W is repuwed WM Pblbe Depmbnent mord Cly cowre�V inqapproval 60 ort+drror to the event Shuttle bus esnnoe wan be uired w+bss sppXaant dernonrtrntes sul4rla an-ets owrrlh0 u erellab/e. Nor►pnglHed event wN not be a/bwed. CONTRACTOR I APPLICANT INFORPAATION: Name: Regal By Andersen Phone:icenae# 1920 County Road "C" West Expiration Date: Mailing Address: ' Roseville,W 55113 Cicell Contact Person: License#20130983 ZIP: Email and/or Fax: 651-264-4777 It is; Contractor / Homeowner tcimio osy PROPERTY OWNER INF RMAT . Name: Phone(day): Address: C. : Email and/or Fax ZIP: PROJECT INFORAAATION: Type M Prollect Any awth movement may require []Door(s) ❑Remodel ❑water Damage tIACWD review&permits 13 Wlndaw($) Minnehahe Cnmk Watershed District(MCWD) ❑Repair ❑Storm Damage 118202 Minnetonka Blvd ❑Siding ❑Restolation [I Other:(specify) pts ate: en,M 1-05901 Re-mof E3 Fire Damage 'c� f=ax: 952-471.0882 eat 044 SOMA 10► Overall Pro i°0t0�`�s� Estimated Construagon Valuation of Project(excluding land) S APPLICANT ACKNOWLEDGEMENT: • Agrees 10 provide 81 Information raqulred or requested by the Building Department; Cwtlfies than the lnformaticn supplied is true and correct to the bast of hislher knowledge. The applicant recognises that they aro ad*responsible for sr�bmitting a complete application being aware that upon failure to do so, the staff has no altemathre but to reject a until It is complete; • Some or all of the Informadon that you are asked to provide on this application Is elaaslfie�i by Stale law as either private or oonfidentlal. Private data is Information which generally cannot be given to the public but can be Given to the subject of the data. Confidential data Is information which generally cannot be given to either the public or the subjed of the data. Our Purpose and Intended use of this information is to annually update our records and records of other governmen aired low. H refuse to su the Information on not be issued tall agendas Applicant's Signature: Data: LAW updated: 06.04.2009 a-d 0619OLSIS9 33IAN3S IIW63d a 9 S m oe ¢ iT 11oz bz Sny