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<br /> To: Page 2 of 2 2014-08-05 14:22:57 (GMT) ' ,- I From: Abba Roofing&Windows
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<br /> Building Permit Applica�ion fo� nttf�ir�tenance I Replacement / Renouation
<br /> (No structural expansion. C�nly windo�rvs, doors, siding, re-rvof, etc.}
<br /> �t���h�\, Mailing Address Permit number (� /� �-" �3
<br /> /� i 'Vj^�,4� PO Rox 66
<br /> � � Crystal Bay, MN 55323-006ia Qate r�ec:eived
<br /> 'i
<br /> � � � Received� .
<br /> � Sfreet Address Y
<br /> 2750 Kelley Parkway Plan review fee
<br /> `��' �� "if Orono, MN 55356
<br /> �:f'<isrs<?� � 3 '. ��
<br /> — Total Fcc:
<br /> Main: 952-249-4600 �ax: 952-249-4616 wv✓�,�i�i.>;oiio.irin.us
<br /> ---.� _
<br /> ?his application form must be completed in full and arl required informakion must be submitted.
<br /> Incamplete applications will be r�tumed. {Please prinf)
<br /> GENERAL INFORMATiQN:
<br /> t'"; `-.
<br /> Jab�Site Address: � 1�,� t i�=�, �-`">������"'r�-
<br /> Will this be a Parade af Homes, Remodelet�Showcase HQms t'�r other Display Hame? ❑Yes u Na
<br /> If yes:a special event permrt zs required yvith Police pe�artment and City Couno'ril app�ova!60 days prror to the event. Shuttle bus servrcz wi!!Ue
<br /> required uniess applicant demonstrafes sufficier„on-srte parking is'availahle. Non-F�ermi(ied events wil!no!be allowed.
<br /> CONTRACTOR!APPLIGANT IfVFORMATIO :
<br /> �.,
<br /> Name: ,�c,�"J��._ ��?�.:� , '�^C: � �'
<br /> �l -\ '\ �--`':,,�`�i'��.5.,w.�,:� T j
<br /> tate License# "� v ��
<br /> _ _._
<br /> � �y � ((r "� _ Expiration date: j �j J �
<br /> Lead Certification Number: �,� ��S"-f,�,>��"� -��;,_� -- Expirat[on Date: �1�, jr�
<br /> (for wqrk on homes that were consfrucfed prior ta 997$
<br /> Phane: �ce�q (office)32d-31 rJ' — �g g�
<br /> Mailing Address: City: ZIP:
<br /> Contact Person: ApK licant is: Gontractor t Homeowner (Circle One)
<br /> Email and/or Fax:
<br /> PROPERTY QWNER INFORMATION:
<br /> Name: �1C�C�--� �'" j�-tilT.t'� ��h1�
<br /> Phone(day): (�.ilL- �`�`��— ?>!."1�`'}
<br /> Address: `��/�� ,�r�,� ,�,,� City:� � ZlP�
<br /> Errtail and/or Fax
<br /> _ ____...
<br /> PROJEC7 1N�(3RiilIAT10N_Overall pro}ect description: �.e=�.�.C�E_c:�:'�., 1.�.,���~����(y`=�°� ,•�o i- �{11Y,�',�,�C S��,��
<br /> Type of Project: Any earth movement may also require
<br /> ❑Door(s; ❑Remodcl ❑Fre Damage MCWD review 8�permits:
<br /> ❑Re-ioof,asphait ❑Repair ❑.Storm Uamage t41innehaha Creek Watershed District(n9C\ND)
<br /> ❑Re-roof, cedar �8202 Mfnnetonka Blvd
<br /> ❑Ra_storatio� ❑Water Camage Deephaven, MN 55391
<br /> ❑Re-roof,other(spec�ty� ❑Siding ❑Other. (specifyj Phone; 952-471 0590
<br /> I ( Fax: 952-471-0682
<br /> �Windcw{s) � wvwe m;nnehah�crEek.crg
<br /> Estimated ConsYruction Valuation af Project(excluding land) ' $ 6=>�7'�"-��t�C_>
<br /> APPLICANT ACKNOWLEDGEMENT:
<br /> . Agrees to provide all information required or reyuested by fhe Buildini�Department;
<br /> j • Certifies that tfie information supplied is true and correct to the best af his/her knpwledge. The applicae:t recognizes that they are
<br /> 1 sofely responsible for submitting a complete application being aware that up�n failure ta da so, the staff has no altematfve but to
<br /> reject�it until it is�C�rnplete; � �
<br /> � g Some or all of the information That you are asked ta provide or, this application is classified by State faw as either private or
<br /> confidential. Private data is information which generally cannot be gven to the public but can be given to#he subject of the data.
<br /> � Confdential data is information which generally cannot be given to e;ither the publiC or the sub�ect of the data Our putpose 2nci
<br /> intended use of this information is[o annually update our records ani f records of other governmental agencies required by law If
<br /> ou reTuse to su I�the�nformation,the a licatio ,m ;net be issue�.
<br /> Applicant's Signature: '%��°�i",:�G� ��`�';�,�1'}t�`��== Date: �';%����
<br /> � �-`7 ` -- _
<br /> Owner's Signature: __ ' Date:
<br /> L'ast Updated:0 310 6/2 0 1 3 �
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