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i <br /> ' ' Confiirmation Report — Memory Send <br /> Time : Oct-15-2009 01:12pm <br /> Tel line : +952Z494616 <br /> Name : CITY OF ORONO <br /> Job number . 127 <br /> Date . Oct-15 01:12pm <br /> To . 9522771690 <br /> Document pages . 001 <br /> Start time . Oct-15 01:12pm <br /> IEnd time . Oct-15 01:12pm <br /> Pages sent . 001 <br /> Status . OK <br /> Job number : 127 *** SEND SUCCESSFUL *** <br /> Oct. 15.' 2009 12: 03PM No. 3852 P. 1 <br /> Gity of Orono <br /> Building Permit Application for Intgrnal Worlc <br /> ��dows, doors s7din . �-roof, atc_ <br /> O.�S���TO n�a✓•P aox 66� Psmtit rfUmWar: G��- �/3 <br /> Crystal Bay,MN 66923-0066 oac..ocoiwcr_ /� /S d9 <br /> 3bwt Atldross: Raoalvad by: �if� <br /> �r, � ��so rc.uaY Pe.x�y . <br /> og�- �rono,nnN s5356 �j/ - <br /> �-r�— otal F�o: .���' /c�: `� <br /> Mafn: 862-2 600 Pax= 9',i2�349-4B'IB w�wv_S-.i_orone_m _us <br /> � Thia appllo�tion form must ba compioted in iuil ancl all requlrod in o rci <br /> IncomPl�W aPPflaationa wltl bo�turned. CP/ease prinV � ���� <br /> QENEl�AL INFORMATIONx ' � <br /> Job Slt's Adtliass_ Z y�7d C�..✓rv�a.�. S�_ _ i <br /> �11 this be a ParadB oF Homas, Ramodelers Showoaso Homo or othat�iapiwy Homs"? Yes Nn <br /> /ly�s,�spaGa/evont po�mlt!s reOWrral wlfn Po/icb Oapaitmant an0 Cffy Cound/approvn/60 day�pr/o�to tha ewnf. SAutI/a bur sarvlee yy4i b� <br /> requlrsd un/ws appJ/r�nr damonsfiafns suiFicient on-adt�parWi�p!s aveilab/e. Non p�isn/Hed events wp/nat bs a/Iowad <br /> CONT CTOR/APPLICANT INFORMA'T'ION- <br /> Nama- . ... . . � . <br /> Stat�l.i 1'�so�Y ___"'_'.._.. Expiration L7ats: �- ��� u1D <br /> Ph one: 9�s�- �-7�-/.�o o CoYfi¢a) �"- <br /> , Malltng tlress: -5 o v Juc, ____ Gitv' o �u_S . 2�P=S53 S/3 <br /> Contact Person: zJ.-c.-. ...dv.:cfa-. Appli�ant�is'��C�on�tra % Homeowner tc�.�.on.� <br /> � �mail ar}p/or Fax: T ,t 9Sa-377-/{r�^� h,.-.��I.�.T�k: �,�� ___._.�_n_Q✓ IQ�,o�3,._c cs rr� <br /> ' PROP6�TY OWNER INFORMnTfoNc / _ <br /> Nama: T c► �e 1�b 1.Q L ti.�c3 <br /> � PF�ona C Y)= _.��ST�—'-'y.71= 7 6r:fU .. <br /> Add�es�� �-�-/7o Caf.. St- City'i(JQ y��� ZIP: S,3�� <br /> ; Email ar7Wor Rax , <br /> .. . . . _ .- .__._...------- <br /> PROJEi T INFORMATION: ' ^ <br /> Typv of j� . -----•Ai�y ca�i mc�vama�may nrqu►� <br /> �� , . � MC!Wb evvlow i pa►mlle <br /> i �Ooor(�� O Romodal O Watar Oamaage � ' : � . <br /> Minnohaha CweK Wyto.r.h�d 016Lfiat(MCWOj <br /> �Wind (s) O Repalr, �Senrm�amape '1�202 Minnotonlca B1vd <br /> O�ephavsn,MN 5539'I <br /> �� Q Siding [7 RastoraOon O Othar. (sPso7y) Phonr: 0$��77-0500 <br /> II 0 Ra- �Ffre Ooma a Fax: 962�7'1-0682 <br /> 9 �mevw. inneV.ahacrealc.oro <br /> ____ _""'._......_�._.._._�._--•-• <br /> '�.. Ovarall�'rojad�asc�iPtiv_�:.. LZ...C�,(�-c:`-'1-S� uS�.do�-.�S 1 r�.��G�is-�:r��o�.++-.t..�S� -- ---- <br /> � Estlma d Co�sstructlo�s Va1uallon ioi Pro dct e:c[uqlc� land <br /> AP�LI �rITiAGKNOWLECGEMENT: _ <br /> • .Tpr�s,Fn provida all Infortn�tion roquil�d or rrqu�ated 6y tFiw Bu7ltllne Oapa�tmonY: <br /> • ��tiflB�6 1hHt tha InfoAnatlOn iup pliod is truo and cofrect l0 Cho bort of hi�/har fcnowl�dgo. THo applicant hCoBrl�Zas that Moy <br /> �rn solely responai6lo Tor auCmlttinp a aompl�os applimdon belnp aWars tF�at upon fallure co do so, tha stary has no alrsmative <br /> 4t�t to rslect it us�tlt K f�comPleta; <br /> $Qm�Qr al� of th� tnformation that you ara ralcad to pravld� on thla applicadon 4s daaa:fiad by Stat� I�w as althar prtvet� or <br /> • c��flC9�ltfal. Prlvata dota ls Information wT.ich ggnarally �nnat bo yWan to The publio but can ba giv�n jo the oubjsct of tho <br /> c��ta. Confidontlal dato Is Information whiah ganarolly cannoc ba plVan to ejthaf iha publlo or V7s.subJea[ of the dnta_ Our <br /> qyrposa an<7 irrt�npr0 usa oF this inPorTotlon Ia to annually update our remrda and ramrds oY othnf..ppvemmsnta! apandar <br /> Lo I tFir Informai o _ li ' not ba ina a � ' <br /> 1 Appliwn'$Signatura: �—�_��.n� - ,8��- oate: -1Q- /S-c�_ <br /> -� ..__ <br /> Lwa upawq�¢: os-joa.save . . . - - -- - <br /> I I <br />