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Dar-08-2D10 01:58pm From-CITY OF ORONO +8522494616 T-669 P 003/003 F-160 <br /> - -� - - : . �..� i <br /> ` Building Permit Application for Internal Work <br /> (windows, doore, s�ding, re-roof, etc. <br /> O�O� MeMng Address: <br /> PO eox 66 Permlt number: o�0lD— O <br /> Q Crystal 8ay,MN 86323-Op66 Dat�e reCenred: / �' /zj <br /> � � SfngAt Aadr+ess: ReCel�eu by� <br /> 2750 Kelley Parkway � <br /> �t� �' Orono, MN 55356 Plan revlew fee: ' <br /> Main: 952_249-4800 Fex; 952-249-4B1B bpdp�,c}�drono.mn ua 7�1 Fee: ��D,� <br /> 7his application f�rm must be completed in full and all requi�ed intorrnativn must be submitted. <br /> Incomplete applicatlons wlll b�retumed. (P/ease print) <br /> (3ENERAL INFORIAATION: �� � COUn'�( <br /> Job 31te Address: �CJ� �� �� <br /> Wlll thi8 be a Par�de of Hornes, Remod�lers Showcase Hom� or other Display Home? Yss No <br /> 7Ya�,e apecie/everu pe�n�t Js�equ1►sd wwrrhh►oi;ce n•pann+er��and c�ty Counc�i•ppruve�e0 aeya prror ro rne ovenc Shub�e bus�e,vrce wra ea <br /> r�qu�red wleas apprlcenf domonet�s auificiant on•ei�per(cMp ie avell�dle. Non-pennlfled aya�f8 wil/�p160 ellowsd. <br /> CONTRACTOR/APPLICANT INFORMATIpN; <br /> Name: Renewal By Andersen <br /> P otne:��nse # 1920 County Road "C" West Exp�ratfon C)ate: <br /> Mailing Address: Rosevilte, NfN 551 l3 C� , cell� <br /> Contact Person: License #20130983 z►P; <br /> Email and/or Fax: �` 6S l-264-4777 �t is: Contractor / Homeowner �c►K�s o�.� <br /> � � <br /> PROPER7Y OWNER INFQ ION: <br /> Name: � ���� <br /> Phone(day): _ <br /> Address: I CI : <br /> Emall andlor Fax 21p� <br /> PROJECT tNFORMATION: ` � <br /> Typs of ProJect "� . � • <br /> An art rr�oveme ay requi� , <br /> i ❑Door(s) ❑ Remodel ❑Weter Damage MCWD�vlew 8 pernlibl <br /> , <br /> CI Window(s) ❑ Rapair Mlnnehehe Creek Waterghed Distdct(M WD) <br /> ❑ Storm Damage 1 B2e)2 M�nnetonka elvd <br /> ❑ Sltling []RestoraGon D�'BPhaven,MN 56391 <br /> ❑Oth�r:(r,peCify) Phane; 852�71-059d <br /> ❑ Ra-roof � ❑Fire bamage Fsz: 852�71-0682 <br /> Overoll Pro ect Descrf tlon: <br /> EBtlmated Constructlon Veluation of pro ec!(oxaludin I�nd) s a <br /> APPLICANT ACKNOWLEDGEMENT: � <br /> • Aprees to provfde all informailon raquired or requested by the 9uflding oapedment; <br /> • Certifie� that the InfCrmatlon suppNed ie true and corrett to the besl of hisfier knowiedge. 1'he opplioani rewgnizas that they <br /> ere solely reaponaibie for aubmlttin0 a complete applicatlon being awate that upon i�llure to do so, the sta}f hae no altemative <br /> but to reJgCt il uMil it i�complete; <br /> • 8ome or atl oi the intormatlon that you a�e aaked to prov�de on this applicetlon is clessified by 6t8te law as elther private or <br /> cAnFdential. Private deta is informatian whlch generelly cannot be givan to fhe publ� but can be glven to 1he subject of t1�a <br /> data. Confldentie! darta f� Informatio� which gener�lly cannOt be glvBn to either tlte public or tha subjed oi the date. Our <br /> purpose and intended u8e vi thts informallon ia to gnnually updete our records and /8cord:+ of olher govemmerttal agencie� <br /> re ulred b leW, N 0�refuae to su ! the informatian the a Ilcation ma nof be Issued. <br /> 4pplicant's Si9natu�e� I�'��J ,�l <br /> 08te: f(J <br /> .e6t Updated: 05�44-2009 <br /> 1 <br /> Z 'd 06Z9bL9tS9 3�IA2135 1TW21�d Q '8 S �I �Z �EZ OTOZ B� �aQ <br />