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. �un, �0, 2011 3: 08PM No. 7529 P, 1 <br /> ,r ,� <br /> City ofi Orono <br /> Building Permiti Application for Internal Work <br /> (wlndows� doors� siding, rc-roaf, ctc.) <br /> /'���-.� Mailir,p�dd�s�: w �armitnumber; —�Q J "/ <br /> O��:� an R��K AA <br /> /Q Q� �ry5tal!lay,MN bti323 0066 Dotc rcccivcd� � I / <br /> 1,� .. StrsetAtldress: HCCCIVC4 Dy: �- <br /> �'a, � �C' 2750 Keiley Parkway Nlan revlowtee: � <br /> �t������ , Urono,MN 55356 � <br /> I otal fec: ��. �O <br /> Mall1: 952=d�19�1B00 Far.: 552-249�618 vsn�w.ci.orano.mn.us <br /> Thls appllcatlon lorm muet be completed In tUll 3nd all required inform�tion mus�be�uDmitted, <br /> Ineomplo�e appllc�clo�s wIU be rewrn ea. (Pleaee p�lnq <br /> GENERAL INF�RMATION; <br /> Job 3ite Address: �]a� (��Wn �`� <br /> WIII thls be a Parade of Homes,Remodeiers Showcase Home or�other Diepley Home'? Ye; No <br /> /fyCR 0 apC[!OI CVClIt pC111i1��S/13UUlld�Wifll PUli�i OgUdIt/119A1 dllJ L11y Ciiwiuiln����iuval HlJ dnys�uiui!nllir.r.vr.�d .Slutlllu/uix.�wrv6a w(q(u� <br /> rr.,��urr.rr����h+c.s�p�pcaat demanetrates sumnenf.m-F1te penun�Is avaua��e. Nrn-pvrm�t�o evenrs wul no+bo quowxr, <br /> CONTRACTOR/A,PPLICANT INFO AT10N; <br /> Name: Jc.��vw'� �`: <br /> 5tate License t� �0 4:�_.... _ EJcplrstlon D3t8: <br /> Pl�u�ia: S�—� '7 7— G v c'� o�ry3 ..�cel�) <br /> MaiGng Address� c>> E' � • � � Cit • , ;�i s �ZIP: :S�S� <br /> Contoet Por�on: ���-�� I«.,d;v��c I,�; Applicant is: (Contra o, ! Homeowner �ci�eieonei <br /> Email andlor Fax: <br /> PRaPERTY�1NNER INP�ltMAYION: � <br /> Namc: r•-�� �u.r� ��S.e. <br /> Nhanc(day): � <br /> Addross: jl �:_ City: �,rc�.o ZlP: L5?�,�� ]W <br /> Email and/or Fax � <br /> PROJECT INFORMATION; <br /> rypo oi Pro�oct; My�vRA movcmont mny require <br /> MCYYD rnvlew&permt� <br /> ❑�nnr(a� ❑R2rtlotlel ❑Weter Uamage <br /> • Wlncl��w(s) ❑RrFx+ir ❑Stortn L�amage Minnehaha.la 01�Aln oWnka B�IVd�(MCW�) <br /> Deephaven,MN 5.`,�91 <br /> n Slding ❑RC�lumliun ❑Dlhai.(�pec:iFy) PhtmP� 4:,?-e7�1-05Gp <br /> Fa�c 96:471 0682 <br /> U Rc-roof I—I�IK Demepe WwW.�lli(Il�rl'ial'iA�Sr.r.k�uu <br /> OvBYell ProJeCt Description: Qp qL� �, ���,�,�� e� 7a,�,�j /�har�, ` „ <br /> estimated Constructlon Valuatlon ot Pro)act(sxcludlog lantl) ��'� �b � <br /> .._ ��2� <br /> APPI,ICANT ACKNOWLEDGEMENT: <br /> • Aqroor to provlde sll inFormation required or requcMcd bv 1hc Building bepartmant <br /> • Cartrnas thsi the informaiion supplied�,uue and oorr�cct to ihe beat oi hialher knowledpe. The applicant recoenizea that ihey <br /> are solely rYyinnsll�lr.f���.ul�rniUin��comp�vle application being awaro th�l upon t111uri to Co so, qte etaff has no slternative <br /> 6ut io rejact�t until it�.oomplctc; <br /> • Some ar all of the information that you are asl�d tu yruvi�fC u�i ui�s ep�,licaliun i���assiA�rl hy Srar�law�s elth9r phvate cv <br /> r.nnflAanflal P►Nate Ca[a is informesian whicn 9enotaqy cannof be given lo the public bu1 ran be qiven 10 thc�ubjcot ef thc <br /> de1a. Confideniial data is infom�dtion Whii:h �encr•dlly�nnul he yivpn tn eAhsr thp puhtlr.nr thP Qiih�rxr.t ni thp tla�2. Our <br /> �iir�n.¢�anrl Intended u5e Of this intorma[ion is 1a�nnually updste aur re�rde 3nd recorclC Of othc�QOYcrnmcntql opcncico <br /> rC uiPCd b low. I u refu9e!o su I !he infortnation tha a licafic,i�nr., nid hr 4kwr"I <br /> Applicanl's Signeture� �� /,���".- Date; �/�1��� <br /> ��P - <br /> Lasl Updated: 05-0•}-2009 <br />