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APR!?0/2015/MON 11 ; 17 PM FAX No, 952 854 4909 P. 002/003 <br /> , , , .. <br /> . <br /> . <br /> Ci�y of arono <br /> Building Permit Application for ln�er��al Work ' <br /> (wii�dows, doars, siding, re-roo�F, e�c.) <br /> rLlarling AddrC�Ss: Permit numbet: � ' S� <br /> � � PO Box 66 '/ <br /> �O� �� Crystal 8ay, MN 55323-0066 Date received: `�-' �� � <br /> �'�i�:+::�r�,, l�eceived by- <br /> � ' »,�� ) Sfreef Address: � <br /> �� G����,.:;��,„- a, <br /> ,�, ;E1, ' «*.,� Gti 2750 Kelley Parkway P;an revieW fee: � <br /> L�'k��'�N��/ orono, MN 5535fi <br /> L �'Lsx�� <br /> Total FeA: ��l �� � �- <br /> Main: 952-249-4600 Fax: 952-249-4646 www.ci.orono.m�.us / <br /> Tnis application form must be completed in full and all required information must be submitted. �'t� � <br /> Incompfete applications will be returned. (F�lease printJ �(�,•��0 <br /> GEN�RAL 1NFURfUTATION: b � � �� a � <br /> Joh Site Address: � 7 G � �a �r� _ � � „ - <br /> Will thiS be a Parade of Homes, Remodei�rs Sl�owcase Home or other Display Home? � Yes ❑ No <br /> lf yes,a spacia/evsnt permit is roquired with Pollce Departmenf and Cliy Council approva!60 da��s prror to the evenf. Shuftle Dus sen�ice will be <br /> required unless appllcanf demoristrates sufficient on-�Ife parking is available. Non-permitted evants�a�ll!not be allowed, <br /> CONTRACTOR/APPLICANT IN�ORMATION� �f�j'� 3YS •Gti �f ] <br /> Name: <br /> 5tate License�t Pella Northland m o <br /> Phone: 15300 25th Ave N. Ste 100 � (cell) _ <br /> Mailii�g Address: Plymout�, MN SS447 Z1�� <br /> Cantact Person: x,iG#BC645U90 Ph. 763/745-1400 {omeowner �c�rci�oRe� <br /> �i�ail and/or Fax: _ <br /> PROPERTY OWIV�R FOR ATIpN- <br /> ���r�: �� a r a� �u�� a M <br /> Pnone{day): b f 2 � �� <br /> Address� a O Gi : �Q T ��a zIP: �S� `� <br /> Email and/or Fax � <br /> PROJEG�' INFORMATION: - � <br /> Type of Project: " . Any earfh movement may require <br /> MCWD review&permits , <br /> �] Door(s) ❑ 1�emodef [,,WatBf Damage <br /> Minn9haha Creek WOte:-shed D',strict(MCWD) <br /> �Window(s) �� 'C,�, .Repai� ❑Sform Dam�ge ' 18202 M[nnetonka 81vd <br /> Deephaven, MN 55391 <br /> []Siding � ❑ Restoration ❑Other:(specify) I'hone: 952-471-0590 <br /> Fax: 952-479-0682 <br /> � [� Re-foof ❑ �ire Damage � � Www.minnehai�acr Icor <br /> Overall Project Descriptian: J G+l R e u J` S J / � l !n �rS 4 <br /> Estimated Construction Valuatiort of Project excluding land) $ L �! l+ b�� <br /> APPLIGAN7 ACKN�WLEDGEM�NT: <br /> - Agrees to provide alf mformation required or requeSCed L�y the Building Department; <br /> • Ce�tifies thaf the info�mation supplied is true and Gorrect to the besf of hislher knowledge. ThQ applicant rBCognizes that they <br /> a�e Soleky responSiblo for submitting a complet�8pplication being aware that upon failure to da so, the st2fF has no aliernative <br /> but to reject it�ntik it is complete; <br /> ' . SOme or all of tPie infonmation that you are �sked to provide Of1 this application is classifed by 5tate (aw as either private or <br /> confidential. Private data is information which qenerally ca��not be glve�� to the public but can be given to the sub;ect of the <br /> data. Con�identia� data is information which gen2raliy cannot be given to elther the public or the subject of the data Our <br /> purpose and intended use of this information is to annually update our reaords and recorclS of other gOvernmenfa! agencies <br /> re uirEd b law. If Ou refuse to su I the informatiDn,the appliCBtion ma not be fssued. <br /> AppiicanYs Signature: �� <br /> T Date: � � 2v ` ! ✓ <br /> Last Updated: O5•04-2009 <br />