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'; , �/�' <br /> ' �� <br /> C� of r �``� <br /> ty 4 ono `� <br /> , Building Permit Application fo� Internal Work <br /> (wlndaws� doors, sidl � re-roaf, etc.) <br /> "'`�n°"°�s'°`a r��,r,�: �//— ,� <br /> �_ <br /> O�,01�0 Po eox 88 <br /> c�e�r,�a��ooeB ow reo.r�sd: / <br /> � sbeet A�wse: Reoel�ea byr ,____.; <br /> � ��K°�°Y���Y Pian r+vt�w fee: <br /> dato,MN S63S6 <br /> ToW Fee: //p/p,�� ' <br /> Modn: 96,Z-24�1800 Fa� Q52,24p�t8 www_ci.grono.mn.us 4 f ; <br /> Thf�appNcsfbn lbmi must b�oomplsmE In tu1 and aN requlred InbrmaUon must be subm�tEed. � <br /> IncomPN'a appllpitlo+»wIN b�rstum�d. (Pk�e print) <br /> OENERAL INFORMATION: � .,j . 1 : �.. � <br /> ��s�.�,�: ��;�—� ��„�.�1.� � <br /> WIII thb b��Parad�of Flanw,R�modN�t�ShO�Csw FionM or otlw Dlsphy Hon»? Y�s No <br /> ��•�•ww vw►�,�t a+•oulr�d w1n Ao�.e7�p�e„«uc�r�d[�y canar qoiw+�eo aiqa�pr�or ro a�s�+�w+c sr�.e.�a ss,v�.we�oe <br /> �sar•a�a,�ws�rr e.�,on.o.e.s�o►.�v.ra►�rr.r.aaen. niar-�.►,,,n�ed s�s►�s►.r na a eeo+rea. <br /> CONTRACTOR/ � � II�'QRYATION: s� \ <br /> Name: , i•/65� oOF��9 � � ��f� 1-�C <br /> smc�u��� 2 o�v Qa �� ��, �: p3i��/�o� <br /> � <br /> Leed Certificcstbn Number. Expiretbn Dete: � � <br /> (1br wwk on Aari�s dl�t oorn� l01�Td .`.."'".. <br /> Pr,one: 76 3�? 7-9 G � c�> 7� 3 a8o- I 3 � c�u� <br /> Mailing Address; S' �`f' City: vG ZIP: �q� <br /> Co�ct Peraon: /t�ry�y � 4,.� ApplioaM is: / Fiomeawner �c�+.o�.t <br /> �►e���a F�: 763 — 51 a 7- Qoo <br /> PROPER7V dWNER I",�oR�/17'� <br /> Name: �.�,��� /'f�5 . <br /> Phone(day)� — � ..... __..._..__ <br /> /a�_ <br /> Address: T � . . � . ',i/ . �%%��- Cfty:G-��/2��' ZIP: <br /> EmaN andlor Fax � �""~ <br /> PROJECT INFORMATION: <br /> Typ�of ProM�t: My.�+�nowm.�e�+�.y�w�e --��---� <br /> � L7 000res) �R�erwdsl p w�r Qam�p � rcwu�.vww a p.nnlb: <br /> Minnah�l�a C�esk WaePeslyd DFaW�t(MCwD) <br /> � p winaowts) ❑Repsir D Storm oarrieQe ; 1820¢Mlnnoton�ca B�vd <br /> � D sa�ng p�tesooranon O omec(s�eab) ' ��•n.tiw 5539� <br /> � I Phone: 962�7t-0sSo <br /> � �Rs-toof ❑F�ns D�n�ege I Fsx: 952-47'1-0682 <br /> � �minnehahacreek.oru <br /> Owrsll ProJ�ct D��iptbn: _..,.. _—. <br /> F.sWriabd Co�structlon VaM�■1i0n o1 Pro��Ct(��q land) i f ��,,�� - - .. _ _. <br /> APPLICAN7 ACKNOWI.EDt3EYENT: <br /> i Agree�m provid�NI aMorm�tion rpuind or roqur�L�d b�►fhs 8ullding DepeM�snt; T <br /> � Cerdfiee It�ai Ihe Ittfo�ritYAbn auPP�ied i�Ove arW cAnect�V�e D6st o(hialF►er ImowledDe. The BpP�nt recopnizss that tney ; <br /> � ere aoWy rsspvn�bls Ibr suibmlClnD++oa'nDiele applintbn bslnp ewaro tt�at upon tailuro m do so.ths�A hos no altemative �, <br /> b�n to r�yeci n w,tll it Is ownplw; <br /> iSomo or all of ttw Irrlb�m�qon thet you an arked b prnvide on this apptk�fiort is ds�aMbd by State law as ehAer prnrate or , <br /> ; oo�lld�ntiel. Pdwtis dt� Is frdonitati0n whM:h p�rl0rad�r oenfl� b• ghren Uo the pubNc bui Cen be glven Do the suDJect of the : <br /> ' d8�a. Cohlld�nWl de�a � Intortt�etion wF�cA �in�rWy cannart bs given 10 eI1Mr the publlc Or ths aubje�,�t Ot tt�e dste. Our <br /> � purpose 6uM InoerWed We d fMfi� Inlonristion IY Eo entKwYy upd�Le our repp�ds end r�ds o(otl�er govsmmentsl epencaes ; <br /> ufred law. If to ihs�orrr�tl�on Ifw ma not bs Issued. <br /> f►PPlicsnt's Signatt►re: � Oate: ��'�I��� � -,_..__.._ <br /> �u�aaea: oa-o�,xa�� <br />