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�ay-it-2011 DA:33a� from-CtTY OF ORONO +A522494616 T-912 P 002/002 F•T83 <br /> , 1 . - . . . . . .. . . 1- • � <br /> ; Caty�of �ran�o . <br /> . Building Pertnit �APplication for i .� <br /> nternal yVork � <br /> (windaws, doors, siding, re-roof, etc.) <br /> Mar7'mg ABdreBs; <br /> O�`�.'�?` PO Box B8 Perm►t number, , <br /> Q GYslal 8ay.MN 5B323-0OBG •-- � <br /> �' Dstte incaived• �' <br /> ��' SheptAddress�. , Recejuecl b . � . <br /> 27b0 KAI(ey.pA�y y: <br /> a � 4rono�NNV 55358 �. P!�!n rsv'�ew les: <br /> MBi�:�952-249.4gpp Fax' eS�-249-461 B , '.o a. Tot�l Fee: <br /> ,. , This appl�cation form mus�t b$completed•in fuU and al!reqW�Mfam � �8�� <br /> ��N�RAL iNFOR�pAT10N• '��Ple�aAP11Cat�ons wiU be retutnsd, p� �must be sr�bmi <br /> ( ease prrnt) <br /> Ja6 S(te Add�ess: � f a . <br /> �11 fhis be a Parade af HRmea, Remodelers Sho�yca r� <br /> ��"",a���A�x,,ermrt�s mau;,�,,,,;dn�o,� a se Homa cr other Display Home? <br /> �4�d tqila89 RPPrl�Bbt abina�lrbste9 OuAlCreRt�����ry G�ound�°pwroval 6a�1sys pnor ro n►e awix. shut�e� NO <br /> P�1�'/iD�a svaNeble. Non.peimrtted Bt�ents wNl nolbe albwe �w�pbe <br /> CONTRACTOR/APpLICANT INF01�AAp ON: . . � � <br /> Narne: � <br /> state lioense�. a LL <br /> � Phone� ' ' . <br /> Mai�n9 Add�ss: � �� ` ' office �P�Fatton D�te: <br /> CQr)tachPerson: � r. � Cit : " ' �� <br /> Email and/or Fau: r a.�r -e ZIP� <br /> �t Applicant is; ontracto � . <br /> ,�r Homeawner •tci„�„o,,,� ,. <br /> PltQFERT'y�WNER fNPORMA�'�ON,, ' <br /> Name: . <br /> Pho�e(daY). "�'�' r��� <br /> Address: � <br /> ��d and/or Fax <br /> _ Z1P: <br /> PRC?JEe1�lNFORMA7'ION: r <br /> YPe af�Pre�; <br /> Q Door(s}... �� �y earth movemont maY quim � <br /> ; , ❑Remodei l�Wafer Da�e • MCWD review g,p�� <br /> Q Wmdow(s) [►Rapair . ❑Storrit qamsge Mi�^�hahe Creek Wate�Dtst <br /> (MCWb) <br /> �Si�ng. � Dee�M��onka BI <br /> , � (7 Restaatlon, L7 Oth�r:(spscity) Ph�+van.MN• S6�g <br /> Ro-roof . Phone. 862,471.05 <br /> ❑Fire Oamage ' F�x: 832-471-06d2 <br /> Overall�Pwjec�4e�cciptian: . a <br /> �°��n�iruction Valuatio�aFPrc3ect exaludin landy. g. c <br /> i'PPLbCANF ACKN01iM1fL.�DGEMENT: : <br /> � `' Apreee Yo proVlde sA.info , . <br /> rmdtlon requirgd or���}»,t�guildl Qe <br /> • Certlfl�r th�tthe lnformation zupp��p�Ua a�d cortec�to the best,ct�hs/I.,�j��led e. 7 <br /> are.solelY rtsRcnsibk tor subrrutqn a <br /> b�t to rejeot a untiJ it;�complete: 9 �plete aPp1iCation being aware th�t upan f8ilure to do b�c�t r+eco nizea tltffi the <br /> • Some or all of the irrtnnnabpn th�t Yau are acked to prov v� no altemative <br /> , c,nnfidentiat, Prhrale datp is in{ormation which ene � � aPA�ication ls ciaaeified by Stat�law as ither <br /> , d�ta. Cortf[deMlsf Oeta ►c infortnation whi ��Qt be piven to the'public but P►�ts or <br /> : R�+ruAd a and Intanded use ot thia irnor � ��Ify�nQt be � ue�8�en to subject of the ' <br /> �iQn ts o.annuaby�p�t�n ta oqhar the puWl� ar che subJe�t the da1a, Our <br /> �"'• , u refuae ra s IMo atio �e Ikation ��°"d ticords ot other povem ents�t seanciea <br /> �pHcant's,S�ri�ture: � . <br /> . ' Oate: . � �i �� <br />