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� , zs`f�� <br /> � y City of Orono <br /> , 6uilding Permlt Appllcatlon for internal Work <br /> wl�dowa, doors, sidi , re-roof� etc. <br /> ���' Permn nurnber o�Ol l-d0 a7 <br /> O.$,O�O Po eo�ee <br /> cn►.a�i e.y.ww�3..oaes o�oe►��: .� � <br /> Sb�et Add�►+rsa: Rsosived by' <br /> � � 2760 Ksley Parl�weY Plen teviaw�ee: <br /> Crono.MN 66956 � <br /> Toml Feo: ��O�O. � � <br /> Mpin: g62.a4g.�6pp Ft�c 952-�816 .a.oron4;mn.us <br /> Thle appYcatlon 1bm�must De compls�ed In fu1 and�tl requtred Infomwtlon must be submitted. <br /> h�cwnpl�applicd�r�ts wlll b�nfum�d. (Ple�es+e pNirt) <br /> GENERAL tNFORrAT10N: `'� <br /> Job Sla Addnss: � � p�L7C'•'��� �i <br /> WIII thls h�a P�rad�af HoitNs,R�mod�s BAowoas�Han�or otlrr Disp�y Honw? Y�s No <br /> Myrr,a�r wwr w�+���rd wv►�o.G.p.ro�,r►K«�d c�aouwwr��p�a►�eo�aas aior�or�..varr. s►w�m.�,s s.rw�or wrr ae <br /> r�p�irr0 t�ts�prO�rY aWno�lf9�IM�rllld�rw ondls pvlmp is avaldere. Non�pMrr�Itlyd�r�MrN nof os s�Mowse. <br /> COM'RAC70R/ INFORMATION: <br /> Name: /t1; (�/d s�- vbF� Sid� d..��0(� 1:n� <br /> Stete Lk�ense# ,Z Q 6V�a 7 7 Expl�ation D�Le: Q3/3/ t� 0��. <br /> Lead Cerblt�tfon Number: E�irbtion Dete: <br /> (fb�wonk on honNr�htt � b 1l70 - <br /> fb <br /> ��: 76 3�r� ?- � c�� ?6 - v- l3 � c���� <br /> Meiling Addreas: �' C`t' CItY' vG ZIP� 3 (q' <br /> Con�d Persw�: �qyn�/� /t��G►„� APP�ant is: / Hwneowner �crtl.o�.i <br /> ��i�a Fax: 763 — ti a�� 4oQ/ .. ._ <br /> PROP�nr owN�t i��at�u►�or�• � <br /> Name: _ ��'""fi�l,�- ��7 �� r _ <br /> Phone(day): , ��(�� <br /> AddtesS: � ,, r� ,�C:� .G�i� Q'r' G1y: �'`�;� '� ZIP: _,._ <br /> Emau andlor Fex <br /> PROJECT INFORYATION: ,�. <br /> i Ty�p�(p�p�p� My N1!!1 mv'rMrM11t 1n�y trqWn <br /> i ❑Daor(s) ❑Rsrnodsl D wa�r Damape � � YCwD nv�wr a p�rn�tb: <br /> � MJnnehahe C�Ic W�os�shsd Olstrict(MCWD) <br /> � O window�s) ��at� L7 s�oRn o�rr� � t�zo2 iwn�swd , <br /> � ❑3iding ❑R�Y�atlots ❑ORher. (spedfY) i ��,MN 55391 <br /> Phon�: 852�T1-0590 <br /> ! 1('�Re'ro°f ❑FN�p�mep� Fax: 952�71-0882 <br /> www_minng[l�acreek.or� <br /> ov�au Pr+oH�t o.ac�ipao�o� .xd �.nd s ��'� � _ _ <br /> esw�a com�eion P�l �+o ) _ _ .._ ..._._-- <br /> I <br /> APPLICANT ACKNOWL.EDOEMENT: ._ , <br /> i ,qgross Uo Drc'vlds aN k�tlon recNk�d or r�qu�bd b�the Buildlnp�eP�M: <br /> ' Certifles tnat fhs inlOm�llon�uDi��trus an0 oonacx oo tlw D�st of Rii/her I�vwle0(ie. The applk'.oM recopnixes tl'tet they ' <br /> i ��y���p e cd++Dls'1e applfcsrion bsinp awore�et uPon fauure to do so, ths s�A hoa no altemadve � <br /> � but to reJec!ft urNN It!s oo+r�pl�6e; <br /> i Sorrw or aR d the Inlbm�llon fAst you �wlcsed to pra�ids on d� appdcetlon 1s�ed Dy Staoe lew es ellt�er pmra�e or ; <br /> ( oor►ilder�tl�l. PrivsOe d� la kKom�sllon wFilrh potyerslly c�nnot be given �o the pu0lic but can be glven m tl�e subjea oi the : <br /> � data. CoMbdeMld d� Is kdbmWlO� wtikti pYnere�y Camot bs plVen �o eill�er t� publlc vr the wb�eat ot the deie_ Our <br /> I purpose and MOsnded ua d it�s ir�fametfon 1� �o snrutdly upde0a our �ecord� and reoorba cf other gwemmentel sgencies ; <br /> � revulrod bY IAw IE vw ti0 K�[�oh N1A�orrnbl01�L1M soDhoalia�mev nOt b�lasued- ,_.. <br /> �aa�re s��re: �: �%.5;�«."l� . <br /> �c uoaaba: os�o,-�o„ <br />