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Jul-28-2009 03:O0pm From-CITY OF ORONO +9522494616 T-678 P.002/002 F-707 <br /> City'of Orono <br /> Building Permit Application for Internal Wank <br /> (windows, doors, siding, re-roof, etc.) <br /> �� Mellin°Andress: Permit number: lTa/q--40/4r� <br /> D „ Q PO Box liki <br /> Crystal Bay,MN 553230066 Data r000ivctd: 7 <br /> 0 9 <br /> `` Received by: <br /> 4, ' {, �ti Spoor Addr000: <br /> yn t, e;:; ,` 2760 Kelley Partway Plan raviow tae:: <br /> Ct 1.!4;01/ Orono,MN MS3 <br /> Neln: 932-249-4800 Fax' ,56Z-242-46.10yr�vw_c�otern mn�,¢ Toldl Fea, ��v20. (AC) OQ <br /> This application Form mutt be oomplatod In MI and aA required information must be submitted. •' • •' 4 <br /> Inuurrrplete eppllcatlons will be returned. (Phase prior) <br /> GENERAL INFORMATION: <br /> Job Site Address: �3: v <br /> Will tnls be a Parade of Horner, Romodolers Showcase Home or other Display "orae? Yes 0 No <br /> lf you,a apocie/even/permit Is requlrad with Pulioa Dvyeitalon!and CO Council approve,co Paid prior tome event shuti'le pax awiviGia will be <br /> raqulrod unToti applicant damonstrataa sufPiokr t omaltm parking;r tlunderbro. Nen-perrnraea events will not be allowed, <br /> CONTRACTOR/APPLICANT INF9RMATIONy- <br /> Nome: •. \ &5 V,'K.ee '`_ .Q�\SS <br /> Stale License i* W ZNpiratlon Date: ,'. = �-' <br /> Phone; i'Z S:Vii ,� n ce _ cell <br /> Mailing Address: M��� .�► , ► .'. NIN ' ZI :.'�_.14144v. <br /> Contact Felson: _�„ Abbl cant -. onirac•7. I Hurnt:uwner <br /> Email and/or Fax: t-- L„.67, - .1,`--S1-. - �Z {CircHOno} <br /> PROPERTY OWNER INFORMATION: <br /> Name; Lt► • _ . . s' ^� _C D <br /> Phones(day): ` ':1 ��Fi� <br /> Address: . •l) 4_. ‘.-51.c' C ': '�_Cl. , ZIP: 6?-4.\ <br /> Email and/or Fes( <br /> PROJECT INFORrtilATIoN: <br /> -type of Project: Any earth movement may rrquirc <br /> • Maven review&permits <br /> ❑Oeorts) I:Remodel ❑water Damage <br /> Mlnnelmeha CI coh WatorsntnJ District(MOwD) <br /> [l Windows) Repair Storm Carnage 18202 Mlnndtonka Blvd <br /> 777777������ Deer haven,MN 553E41 <br /> CI Sidmg 0 Rasturdtion ❑Other:(specify) none:one: B82-a/1-0500 <br /> Fax: 062471-0682 <br /> Rmeruuf • _ ❑•Fire Qame0a wvnu.rni=aooar o k.° <br /> Overall Pro ect Duscriution: <br /> Estimated Construction Valuation of Project(uxduding_land) $ t ci• <br /> APPLUCANLACItNOWLEoGEMFNT:_ <br /> • Agreee lo provido all Information required or roqu03100 by the t3ullding Deportment; <br /> • Cartifie3 pent the infvrnaigvn dutplled Is true and correct to the best of hI5lher knowedgo. Tho applicant recognises that thoy <br /> are aulaiy reiviitill.)10 for submlttlnp a complere application being aware that upon rair.tre to do eel,IN staff hoc no altornotiva <br /> bum 10 ralect 1t until I;Is=opiate: <br /> ■ Born©or all of the information that you are naked to provide on this upplivatlun lu olassIfed by state law as either private or <br /> confldertlel. Private delta ie intemtatlen which yceeerally cannot ukf Chien to the puellc DUI can be piven to the sub)ecd or IN <br /> claim. Confdantiai data I3 information which ualieratly cannot be piven to eiUi r me public or the suplect or Inc)data, Qur <br /> pvrpuse and Intended use at this Information Is to annually update our records and records of other governmental agencies <br /> ru u re b w. qtt mown sunnl r�r e Information,Rea applioarlen may not be issuod, <br /> Applicant's Slinature: ele../C—(19""' Data: / —ap 9 <br /> Le*updated: 050-zoo , <br /> ,(Q,z (9),, —7 , 2,8 , v5s <br /> , <br />