Laserfiche WebLink
. <br /> G�ty of arono . <br /> �uifding Per it Applicatlon for Maintenance / Renovation <br /> windows, doors, sldin , re-roof, etc.) <br /> MallingAddrsss: permitnumber: �l � 7� <br /> �� PO Bnx 88 <br /> Q Q Cryslal Bay,MN 66323-0088 Dete reoeived: —/ � � <br /> a,� , $� Street Address: Recetved by: � <br /> `� 2760 Kaliey Pa►kway Plan revlew fee: <br /> Orono,MN 66368 <br /> ' Toial Fee: / 5� ,3 j <br /> ain: 852-249-4B00 Fex: 952-248�QB16 �vtw�.cl.arono.mn.us ,/ <br /> hls applicatlon fo must be complated in full and ail required informatton must be submitted. <br /> i compieto applloa�lans wiil be returned. (Please print) <br /> QENERA!IN�pRMATION: <br /> Job 5ite Add�ss: �.. � l�y�� 3 �x,° �° <br /> Will thie ba a�Parade of Hames Remodelers Shawce��e ome or other Dieplay Wome7 es � � <br /> lfyes a apec�al event pemrM Is roqu d Wkh Potfce Avp9tlrnent Rttd CI(y Coundf epprova/60 daya prior to the event ShuNlo bt+a aervlca w be <br /> reqWred unlesa epp!!ca demonslretes aulflclent on�site perkingls�veTlable. Norrpertnff(ed eventa w1ll ttot 6a allowed. <br /> GONTRAGTO�Fi/APPLtCANT i FORMATIpN: <br /> Name: �- � O Yt.�G7�'O►� <br /> 3tate License# G, � Expiretlon Data: <br /> Le�d Ceriiflcat�on Number. �� p Expirat(on Date: <br /> forworkonl homesthAtwere n fruofad rlarto�8 8 <br /> Phone: . (office) 'U II) <br /> Mailing Addfe�s: � .. v-L Zu o �nY: � . ��P: <br /> Contact Pe�so�: Applicant is: a ot / Homeowner �arw. n•� <br /> �meii and/or Fax; „_.� ve� c�, <br /> PROPERTY O'AINER lNFORM ION: ' <br /> Name: ' y�� �' <br /> Phone(day): as . �'� <br /> Address: I 'b0 City: �.�o iuZIP: <br /> Email and/or F�x <br /> PROJECT IN ORMATION: <br /> Typs of ProJect: Any eanh mova►nent may roqutre <br /> ❑poor(s) D R odel [�Ftte Damage MGWO review 14 permits; <br /> Minnehahe�Creek Waterehed Dlstrlot(MC D) <br /> ❑Re-roat,espinalt ❑R elr ❑Siom►Oamage 18202 Minnatcnke BNd <br /> ❑Re-root,cede� ❑R torallon ❑Water Damege Deephaven,MN 68881 <br /> Phone: 852-471-0690 <br /> C]Ra-roof,other(speotry) p si Ing ❑Othar.(spealfy) Fax: 852-471-OBBa <br /> �.m(nnshshacreek.oru <br /> . . ❑ dow(s) <br /> Overal)Pro eo Descri tlan: InJS , ,tO11��It 303 _ <br /> E$tlmated Canstruction Valu ion of Pro)aat exaludtng land S72�OU0 D�,� <br /> APPLICANT CKNOWLED EMENT: <br /> . �qrees l provide all Info Non raqulred or requeDted by the Buliding Dapadment; <br /> . Certiflea�et ttte InfOfqt6fl SUpplled(S ttUe a11d CotfBCt to the b0st of hi6fier knowledge. 'fhe applicant recognizes t they <br /> are solel responslble tor bmflting a complete appilcatlon baing aware ihat upon fatlure to do so,the steH 6as no slt rnadve <br /> but to reJ ct h upUl(t Is eo lete; <br /> • Some or a�l of ihe lofonn ion thet you erp eskod lo provide on this appticalton Is Classified by State law es e(lher pd Ate ar <br /> c9n1[deni at� Private data e intorma8on whtch generaily cennot be given io the public but can be given lo ihe subje ot ihe <br /> ' data. C�nfldendai data I Infotmation whloh generapy oannot 6e given to elther ihe pubitc or the subjed of 1he dat . Our <br /> purpose nd Intended us of thls infarmation Is to annualiy update our racords and recards oi other govammental a ndes <br /> re uired law. If u ref e to 1 the fa aU the a IlcaUom m �ot be issued. <br /> ' 1/20/2016 <br /> ApplicanYs Sign�ture: oata: <br /> Lpat Updaled: 08-09.2011 � � � /� <br /> � •llCi'�� / <br /> '� � <br />