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City of Orono
<br /> Building Permit Application for Maintenance / Replacement / Remodel
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<br /> � ��3 Box 66 � P'erm�t ru t���� 8
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<br /> % C�,�sta! 8ay MN 55323•00�6 Date rece�r.a U -?J—� s ,
<br /> � R�CEIVEp -
<br /> � �� � � St��ee�:;ddress Rece�ven r,��
<br /> :�„ i 2750 Keliey Parkway ' Plar r�v Y.,, '�c A��j
<br /> ' Or�nc MN .�5356 U� ��15 p
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<br /> , M�; :;�-�cy 4�0� F�� s�2-�a5 as�� � CIT�'OF�RONO�
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<br /> � Th�s app���auon forre must be compieted �n full and ail reCuired �nformat�on must b� <.:... ,;;ec IIIGJ�
<br /> Incompiete appNcations witl b�returned. jP�c���e pnntj �,�;ti� �
<br /> GENERAL INFORMATION:
<br /> .;ob Site Address: ::'�L�__.iluclwC�Od�° ..ta���,ri u�
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<br /> WiU this be a Parade of Homes, Remodelers Showcase Home or other Dispiay Home? �Yes �o
<br /> if yes .�..:,� C �c ;; �e� ,•,r�� �e Deaernen�arn7 C{y Cduncii a�provaa 60 days prwr ro the even? Snutt�e n�s se�v�ce w�n be
<br /> �u : ;.e . �tr„ ,-,�, ^+p,rn;;�r ;te� s�H,,e��•C .,t�e parh:n�,s avartaD/e h"on-permRieO events wt(I Rot De BiJo�tiCd
<br /> CONTRACTOR ! APPLICANT 1NFORMATION:
<br /> Nar-.e Nort;t� Hi1l �artners Inc DBh Acme Awning
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<br /> :�tatE L fcens�s� I R E�6 7 2 5 - -
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<br /> Exp�rat�on Date 1 2/31 J 1 5
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<br /> ,_�ad Certi',cat�ur NurTiber Expi�aUon Date
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<br /> r�or work on homes that were constiac[ed piior to t978 —�`
<br /> �hon� ce�� c 1 �-�31 7-0�45 (off�cei 61 2-722-2731
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<br /> Gre fiant�l_A _ � ____�_.___�__� A iicant is C^ontra�ia ��.___ _
<br /> P�1ai�ir� A�drpss 320E B1�omirr ton
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<br /> � __. PP r ' ? Homeowner �Grci�On�)
<br /> Fina;: �rd;orFax gr�c�@armeawninq.com
<br /> PROPERTY OWNER INFORMATION:
<br /> �'d."" ___Ca� yar�_�tileirc�rial Chur�h_ �,
<br /> ''`'�'" d�Y1 952-356-6�88 ---._—_�__.____.__ __._..__._
<br /> ___ ____.. _.-_ __----
<br /> Ac�ress 2�120 Dunwc,ody Avenue Cfty 69ayzata ZIP 55391
<br /> E� a;� and�crF�ax Zsqd�szyns@yahoo.com __.__ __.._._ _._..^_�._-._ __._���
<br /> - -- __._�.._._._.__._,_.._LaVonne Grundis__ _-------------__.
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<br /> PROJECT 1NFORMATION: O�erau pr�1ec:t_urs�;r�tion
<br /> _..._
<br /> Type ot Pro�ect Any earth movement may also require
<br /> .. � v ,-- Rernode� � i•,re Uarr-ag� MCWD review 8 perm�is:
<br /> �,.� R� �;,� asphalt .� R�pa�r �; Starm pamage Manneraha Creek Wa[ersned D�str�ct tMCWD�
<br /> — 18202 Minnetonka Blvd
<br /> R ;,,;� cedar ;� Res±orarc;r �Water Damage : Deepnaven MN 55391
<br /> _, �ca-rc^i othei�specify� �': S+��ng ���mer tspecify� Pnore 852-a7i-�5�0
<br /> � , Fax 952-4'1-0682
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<br /> cstimated Canstruction Valuation of Project (exciuding iand� $ 9 6 5. d 0 -""� "` `"
<br /> aPPLICANT ACKNOWLEDGEMENT:
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<br /> • ryr C*=�:,, ., ;„. , �. ..: x . ::,r reques[ed by th�Budo�ng Qepartment -"__ ____,._____
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<br /> �-�e.v espo�sib�e �ce suQr��r,ng a comp=e�e app:rca:,or be�ng aware that upon fa�iure to do so the staft has no a+ternaUve bu?to
<br /> ::a !until�?�s��om��ete
<br /> • �o�re �r aii wf �he ���orrnat,o� that you aee asked to prov�de on ;h�s appl�cahon �s ciassGfaed by Stete 18w as either pr�vate or '�
<br /> :nrt;ntr�;a� F�rrvate cata ,5 rr��f�,rer,a�,on wh�cn genera��y canrot be e��ven to the pubi�c but�,an be g�ven to the sub}ecC of thr data �
<br /> C,�nt.,,�nt,a+ d�ta �s :��fo��at�on wh�ch generaiiy carnot be���en to��ther the publ�c or ihe sub�eCt of the data Qur purpose ano i
<br /> ter,��ec use of in;s rforrn��is :0 ann� ty pd2te��r recprds antl recasas of other governmental ager,;,�es reC�u�red by tavr If :
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