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��.� ��� �� � � � <br /> Caty of Orono <br /> � <br /> , Building Permit Applicatlon for Internal Work <br /> rvrndows, doors, sidi , re-�'oof, eotc.) <br /> �.p�. ���" ���: o //�-(�03� <br /> 0 0 ��.��� ��: , � <br /> �� s�.c�: ���►� <br /> � � �.�►� P+�,�►�: �..�—� <br /> Mdn: 952,249�800 F�c 952-2�&4616 tivww.ci.orono.mn_ux Toml F�: ���� <br /> This applkarion form must bs canprb�d in fu1 and ad required Irrtiormatbn must be submltted. <br /> h+oo+n �PP�ioaetlons will b�ntu . (PAsese print) <br /> GENERAL.INFORYATiON: � �? ., � <br /> Job sla Addnss: � �;�CJ IG���. " <br /> YYIII tbb b�a P�n�d FiolrNs,l�nwd�i�s F1onN o�oeh�Dl�pf�y Flon�? Ya ��No.,.�_�_ <br /> �f�w,e aDsc1M wwr D�►#b��d w�►FbMer Drpnprw+t and C�'Co�v�oi�PP�r��W P►lor W Lns srwK SM�fd.bua s�Mw wAl ee <br /> �.pr++�e uwas,pp�nr�r an�onea.Me arind�nt or+dNs vr�dr,y a aa�.as. IM�n,p�►r�r�.a�+�1s»�r�or a e1�o�rea. <br /> CONTRACTOR I INFORIIATION: <br /> N.me: /19; W�S* oaF� S�� l.Ahdor.d L�� <br /> StaUe Lbense# QOII O 7 7 Expiratbn DeLe: Q3/ � b'i ��a. <br /> Le�d Certl�atlan Number Expiraticn Date: <br /> (Ibr worlc or�han�dnt oa�splN�� b 1�7d "..'-. <br /> �o�e- �b 3�i� 7.��� � c�� ?6 3 a�8v— 13 � c���� - <br /> �un9�wdress: S cY- ccityy: v� ziP: 6 q <br /> Conted Peraon: ti �,� AAPlic�rn is: ! Homeawne� �c�.a.i_.� <br /> Ernal�ancilor Fax: '�63 - Y �7- Qao/ <br /> PRQPERTY OWNER�y� // <br /> Name: �''�� �- '��� . �`\'Cp/� S�'/'. <br /> Phone(day): . � __......._ .- <br /> Address: � ��� j i G� _{T" �i';(/� City:�G-C��,`���IP: __.. <br /> Email and/or F�x <br /> PRO.lECT INFORMA710N: <br /> Tpp�of ProJrcl: f M�r�tA n�own�nt m�y r�quln �� <br /> MCWD ewrNw i p�mdb: <br /> Q°o�c6) ��""'0d°� �W�°arna�° I NWmet�ahp Cro�k W�Eerst�ed Dtstrict(MCWD) <br /> � ❑Window(e) ❑RepN� ❑8'eoRn Darrwge i 18202 A�u1�tDnka 61vd � <br /> ! p sld�ng ❑R�Lor.tion ❑od�:lspeolfy) i pn�one� 9�8��2�i�-0 o, <br /> ' (y'�Re-roof ❑Fhe DBmpe � Fex: 952-471-0682 <br /> , www.rrun ehahaCreek.orc� <br /> Ov�rall Pr+oj�at D�rlptlon: <br /> EstlR�sd C.orubn�tlon V�atlo�of ProJ�(�xcludl b�nd) s < <��;�',�% _ ^ . <br /> APPUCANT ACKNOWIlD�3EMENT: ^ <br /> �- Aprsso m pia+rlcM�A frAortrn�tbn repultrd or reqwso�d by tl�e Bulidin�DepeM�ent; <br /> � C6rtffiBs V1�t Ihe�fNOm�flort�t�pp�e�d i�frW and CortYCt LD the beSt o�hIBlllsf Iu10�wlsdpe. Tt1e �DPIIcaM reCOpnizes V181 they � <br /> i ��Y�����°�P��PD����ew�r�Ihat upon feilun m eo ao,tns�a1T has no a�temeuve ; <br /> � but o�r+eJact R ur�lA ft is oonpl�e; <br /> j SoRw or a0 of� �omatlon d�et you aro asiostl L�povlde on tfda applicatbn la dnsilfed bY Sta�e Isw as eftnar p�vete or ; <br /> � oonlidentlel. Priw�d9�e !t tf�ortn�tlon rKiiCh QeneraMy cennot be yiven �o the publk but can be qiven tc the subjed of the <br /> � ddta. ConAdMltlal d�e b �ortnabon MA11Cl1 �raMy C81rqt be piV�9n OD ONI� fflv p��liC or the silbalCt of trte deta. Our ; <br /> ' purpoee and Inb�ded uM ot Ihh Inlom�ttion b b snnuaYyl updaUs our r000rds 8nd ncords of otfwr govsmmental egancles ; <br /> � reaWred by law tf w�e�iae to auoohr!hs h�ort�lion ttw wdlostion mey not be�uod <br /> APPllcant'a Sipnature: Uete: ;' �C�� �� <br /> �uvaeoeo: os�o�,zo„ <br />