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Apr-26-2D10 11 :03am From-CITY OF ORONO +8522484616 T-219 P 002/002 F-878 <br /> . � . , - -- -. <br /> - Building Permit Applicat�on for int��nal Vllork <br /> � win�iows� �dqairs, s��l�ng, ro-rcof, etc. <br /> Mal�1n9 Addrnss: <br /> ��� PO Box•98 ,perrnit�umber� �Q/p �!� <br /> � Q Crystal Bay, MN 55323-0086 p�recdived: '� � p <br /> (� '� � 5t�at Add�ss� Recelvee by: <br /> G`F 2750 Kalley Parkwey <br /> t`0k Orono,MN 5535B ` P���OV1��; <br /> MaM: 9b2-249-4600 Fax: 952-248-4818 y�vw.cl.orono.mn'ua To4al Fe�i' �a� � � <br /> This application iorm must be.cornpleted in tull anC all re,quired i�orrn�tlon muet be suhmitted.' ' <br /> Incompleto appllcetions wlll be retumea. (Please pnnt) <br /> GENERAL INFORMATION: � <br /> Job 8ita Address: ' �,�� ��u� <br /> Wfll this be a Parede of Nornes, Remodelsrs Shawcase Hom1e or cther Display Hcme? Yes No <br /> 1f ys.,e rpeCla�eMsnt Parmft/S I1lqu/nd w�fh Pallas D4p.rtme�t ond CQy CouY�Ci/app�pvo!6p epy�prlor Ip�ye p�yAt. Sh�h�bus s�M�oe rrlN be <br /> roqu/res unlesa epplicant demonslnrMs suA�lo/anton.�lte perrrlrfg.is�volb#DM. Nt�n-p6rmlfEede►�en�s wlU nct be ellowed. <br /> CONTRACTOR/ApPLICANT INFORIIAATION, � ' . � <br /> Name: Rencwal�y Ar�derser� , / �' ' <br /> 5tate Licenae tt �� <br /> Phone: 1920 Cour�ty:Road "C"�West, � . Explration[)ate: <br /> Malling Address: R�seville, MN 55] l 3 , . cell <br /> Contaot Person: License#20130983 � C�� � Z�P� <br /> 6mail and/or Fax� 65�=264-4777 � �t�s� Contractar � Homeowner �c�a o�.} <br /> PROPERTY OWN�R INFORMATIQN' � ` <br /> Neme: A t�:� Z,h <br /> Phone(day): _� g�}�_� . <br /> Addresa� !� Ci : Z1P: <br /> Email andlor Fax . <br /> PR�JECT INFORMATION: ' � <br /> Type ot Projeet: ; <br /> �• , Any eartto movemant may rmpuire <br /> ❑Door�a) ❑R9r11pdel ' ' ' ' MCWO rsvfew 8 pennits <br /> 0 Wetar Damape ' <br /> ❑Window(s) ❑ R Ir � � ' � � Minnehaha CreaK V1Jatershed DistrlCt(MCWD) <br /> � ❑Storm�pam�ge , 18202 Minnetonka BNd <br /> �� . � <br /> ❑S}ding ❑ Restorstion ; [}Other.l GSAeafy� Pho e�V95,2�71-0590 <br /> ❑ Re-roaf ❑ Firo Damago FaX: 932-47]-0882 <br /> Overell Project Dascrlptfon; ,`,t�i�5�: � ���� O � � <br /> Estlmatad Constructlon Valuetion�f pro ect axeludin land) : '�j � <br /> APPLICANT ACKNOWLEDC3EM�NT: <br /> • Agrose to provide all informatlon�quired or requas�ed by the Bulldinp D6pactrnent; <br /> • Certifies that It�a lnformetian supplied i9 t�ue and cer►ect fo the bast of his/her knowledge. 7he applicent recognaes thal lhey <br /> are solely respansible for submltting e complete applicetbn being aware fhat upon failur�e to do so, the stefl has no altemetNe <br /> but to rejeCt d until it ie cernplet�; <br /> • 3orne o�all of the�MprmaUon that yau are asked to�prouide on thlg appl��tiQn is �leasified by Stal� lew as eNho� pme�t6 or <br /> oonfidenti8l. Prfvate data I8 iniotmation which generally cannot p� g{v�n to the pubiic but t8n be glven to fie subJeGt of th6 <br /> data. Conflden6al dafa is informetion whiGh gen�r811y Cennot bre:given to either tha public or the �ubjact of tl�a date. our <br /> purpo�e end IMended use of this infOrmetfOr� ie,tq an�udlly update ou'r�feoords end reoords oF other governmeMsl egencleo <br /> _ requfrcd bv law. (f vou refuse to su I the Informatlon4lhe applicelfon mav•not ba lesued. <br /> , : ;� t �_,.. <br /> 4ppllcant's 5lgnature: �� � ' � <br /> � oe�: �� 14 or►► I D <br /> 116t Updalod: OSO4-20p8 <br /> Z 'd ❑6T9bG9IS9 3aIA213S, 1IW213d Q '9 'S ('1 SS �OI dTOZ E2 �dFi <br />