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Ju1-07-2010 02:32pm From-CITY OF ORONO +9522494616 T-349 P 002/002 F-317 <br /> —••> ... �r� v��V <br /> - � Building Permit A�plication for Internal Vllork <br /> (windows, r��oors, sid�ng� re-toof, etc.) <br /> Malling Addig9s: <br /> ��'��7' P0 9ox 86 �' permit r�umber: �0/D-G}� <br /> � Crystel Bay, MN 55323-0068 Date reoe�ved: � /D <br /> '� 5heetAddreas: Reoeive4 by: <br /> 2760 Kelley Parkway <br /> `k �y� O�ono,•INN 55356 p�an revl�wfeo: <br /> Mein: 962-249�4800 Fax: 682-Z49-4818 }��ci.o�nn`�n L� r�+e1 Fe�: �`/,39��� <br /> This appllcation f+onr� rnuat be cpmpleted in Tull and all required fnform�tion must be aubmitted. <br /> Incomplete appllcabons wl(I be retummd. (P/eese print) <br /> C3ENERAL INFORMATION: <br /> Job SIM Addross: y� � �Q�� �Q <br /> Wiil this be a Parade of Hornes, Remodelers Showcase Home or other Display Home? Yes <br /> yY�, e spacle/o ver�pernyt Is roqu�rsd witlr PoAoe pep,ynn,ent end Gl�y�ounci/apprv�a/80 d�ys prior b h�s ewnt. gt,utNe bw se,y;«w1u� 0 <br /> �equ/red unleea sppporn►demonansro�sc�Rlcient on-a1M,oeMdnp is ove�lap/e. /�,rt.perm/tfsd eventa wlfl►at 6e e�bw�e0, <br /> CONTRACTOR/APPLICAN7INFORMAI'IQN; <br /> Name: .� Renewal By Anc�eS�et� � I . <br /> P h o n e:��n�e* - 1920 Co i u�ty R o a d '�C,� Wes t��' ' E x p i re t i o n D a t e� <br /> Ma(ling Address: R�seville, MA1 55113 �', " - celt <br /> Contact pereon: �` Licens�#20130983 C'-�__ Zlp: <br /> Email andlor Fax� 65l-264-4777 , �t is� Ccntractar / NQmeowner �ci�cio o�.� <br /> PROPERTY OWNER(NFO MATION: <br /> rvarna: G ' �V3L.(:� <br /> Phone da � <br /> � Y)� .y� . <br /> Address: �5: <br /> �mail and/or Fax Cit : Z�p: <br /> PROJECT INFORMATION: <br /> lyps of Projece� <br /> Any,sarth movsmertt may raqule� <br /> ❑ Door(a) ❑Remodel ❑Weter pamege � MCWO rovisw g perm�t� <br /> ❑Window(s) []Repe�r ❑3torm dBmage F Mlnnehahe Creek Waterehed Dist�ict(MCWU) <br /> 7820�Minnetonka Blvd <br /> ❑ Sidinp ❑Reaboratlon � � � � Deephaven,MN 53381 <br /> ❑Other. (Specify) �' Phono: 852-471-056p <br /> []Re-�Of ❑Fire pam�ge ;' ` . Fex: 982-47�-0882 <br /> Ovar�ll Pro eet Dsscri tlon: www•minnengn�►,poo-,,.,,. <br /> Eslimatod Constructlon ValuaHon of Pro ect o Cludln laqd) � ��� �� ' <br /> � <br /> APPLICANT ACKNOWLEp�E�pENT: <br /> • A6fe��provlde all irTfomtation required or requeated bythe euilding Oepertm9nf� ' <br /> � C6RNle8 thet the Inforrnation supplied is true and cortoc.i 1p me best of hle/her knowled 7he e <br /> are solely reaponaible 1or supmitfing a camplete application beinB awe� th1�t upon feilu�re to d�ao,fhe�staff heanr�io altematl�ve <br /> but t0�ejeC1 k undl it ia cornplete; <br /> � Some or all oi the fMormat�on that you are asked t� pro�ide on th(s applicatlon i' claesiRed by State law as Bither <br /> oonPfderKial. Privele data ia intormation which genera��y ���o� p� A�en to the publlc but Can be n►en to 1he eub �V�e ar <br /> deta. Conffdentfal data i6 information w}�iah generally can�ot be gfven to e(ther the public or the eubject of the date. Our <br /> purpose and Intended uee of th;s Inlprmation Is tc annuelly update our recorda end records of oth�rr gp�ernmental egence8 <br /> re ulred b law. IP ou refuae ( a I the fnfarmetion the e f tion ma not be lasued. <br /> ,!1,Ci " I�./ <br /> OPl��ant's Signature: ��v/ O <br /> � � Del�: <br /> � � <br /> i�l Uptlefed: DS.Oq-2009 <br /> 2 "d 06S9bG9TS9 3�IA213S 1IW21�d a � S I'I G0 �4T OTOZ GO i�C <br />