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. City of �rono <br /> �3uilding Permit Ap�ltcation �Far �Illaintenance / Renovation ���:'� <br /> windows, daors, sidin , r�-roaf, etc. ��c � 7� <br /> { <br /> MaAinp Rdd�es� Perm��umber, 2075-- (J�t� 7 <br /> Q.�O�� PO Box 66 _ <br /> Crystal B�y,MN 55323-00B6 Bate received: /S . <br /> � 5"dreetAa�i�sa: Received by: -_ ��� <br /> �750 Kelley Paticway Plan revf�+v fee: <br /> � � Or�ona�MN 55356 � <br /> Totaf F�e: Z��, 2� <br /> Main: 95Zr249-4600 Fax: 952�24&4616 �.�.oro�o•mn:us <br /> This appllca#ion f�rm must be cample°ted in fult and aH required ir�forrna�lan must be submite�d. �{J�� /yrcc� i n� <br /> incomplet�appllcatlwts wiil be return�ed. (Plsase print) f f? �.-���a�-e u.�/ Z <br /> �ENERAL lNFCRIIAATION: �yy O ��� r,��'�1 � `�.�� /���'i�- <br /> Jcb SiGe Add►ess: <br /> VYiU th�s be a Parade o!Homes,Remodelera Showcase Mortt�or other Dlspl�y Wome? Y�s NQ <br /> If yos,e s�ecJs!event perm�rs requfied wlth PoAc�DeAa►btrerrt end Clty Gbuncl!8ppmvel 80 daye prior to the sv�ent Shuttle bus se�vloe wlll be <br /> requN'ed unless appJlcant demWlsbst�s BuRfClent on�ife paYl6ng Je AvellablB. IYonpemt!lted 9verrfs wil!not be ellowed. <br /> CONTRAGTOR/APPLICANT INFQRNIA7idN: <br /> Name: t�arv,�.�,r�� '� "Ar�t�S.e� <br /> State License# G13Qq - - �cpiratian Date: 3131, -- -- <br /> Lead Certfflcetion Number: �j��'r ���$3 -� Expiration�atg: <br /> (for work o�homes that wers tor�sWct�sd pr�or�c 1 Srg <br /> phane: (051� e�(D�1-4�0 g$-�MA++ (ofice) (cet!) <br /> Mailing Address: � �•�,•� {�e CitY. ; � ZtP: �' <br /> Contact Person: Applicant is: ! Womsowr�er {c�ro�e ony <br /> Email and/or Fax: <br /> PROPERTY OWNER 1NFQRMA'TION: <br /> Name: �jGt1� �,� • <br /> Phone(daY)' � S.o��. �-`� '" �(5' <br /> Address: �.�� _ _, CEtY: _ ZIP: <br /> �mai!andlar�ax <br /> PRQ.I�CT INF�RMATION: ' <br /> Zype of Projed: An�l earth moverttent may requlre <br /> (] Door(s) ❑Remodel Q Fire Demage MCWD revta°w d�permits: <br /> Minnehaha Creek W�rshed DEstrlct(MCWD) <br /> ❑Re-roof,aspi�eit [�Rapa[r ❑Srorm Damage 98202 Ml�netonka Btvd <br /> � Re-roaf.cedsr ❑Restoration �Weter Damage Deephav�n,MN 55391 <br /> phona: 952�71-0590 <br /> ❑R�..roof,other(spacty) []Siding ❑Other.(specafy) Fa�t: 852-4T1-0682 <br /> �WEndow(s) ��0.C.@ � �'`� S www•minnehahacrePk.s� <br /> p�rera[I !�ro oct Descri on: � �S t� , <br /> Eatlmated Conatructlon Vaivation of ProJect �xcluding land , � /4 � . <br /> APPLiGANT ACKNOWLED{3EMENT: <br /> . qgrees W provlde alt infom+ation r�quired or requ6st�d by the guilding pepartrnent; <br /> . Certfies that the iriformation supplied is�ue and oarrect to the best of hEs/her knowle�ge. The appltcant reoogniz�s that they <br /> are solely responslblo tvr submft�irig a comple�app[Ication being eware that upon fallure to do so,t�s st�PF has no afternat�ne <br /> but#o reject it untii it i6 camplete; - <br /> . Some ar ail af the irtformaffon that you ar�asked bo provlde on this application Ia Gassified by Sla�1ew aa either private or <br /> cQnfldeMfal. P1�vate cfata is lnfatTnatlon vrhtch gen�atly can�ot be giv�n fla t�he public but can be given to the subJect of the <br /> data. ConfirferrEial daFe la irifortnaaon which gerserapY cannot be glven to e'�er the pu�llc or the sub�ect M the data. Our <br /> purpoae and irnended us� of Ehis infa�m2�Gon Is to annually update our records and recards of other govemmerrtel egenaas <br /> uired b I�w. If u rehjse to su the inivrrnstion the ficatior►m� not be issued. <br /> �►,-� ��A�(�I is� <br /> AnQlicant's Sianetura: Date: <br />