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_ , �. - <br /> -� , <br /> Ci#y �f C�rono <br /> Buildir�g P�rmit Ap�plic�ti�►rr far tn�ernat Vttork <br /> (wirrdc�ws, daors, sidi�tc�, re-roc�f, etc.) <br /> Mailing Addr�,ss: permit nurnber� O 0 <br /> �''.�,C)�.`.� PL]enx 86 <br /> i f�}# {��,` Crysta!Bay,MN 55323-�06fi Qats rer.eived: - <br /> Ia ` ,� ,,,J�t srreet acfdr�ss: ( �ece,v�d tsy� <br /> \��'.,� � +��' ��l�' 27�0 Keiley ParsewaY � r�1an review _ <br /> �'�.'�sk.� Q.'"�+,�� t}rono,MN 5535£ '� ^�i/ <br /> ;�-�c�:<�'. / � <br /> ----- T�tat Fes_ J <br /> Main_ 952-249-46�U Fax: 352-249-4616 u�vwr.ci.arano.mn,us <br /> This applieatior�fom�must k�e c�re�pteted ir�fuli and ail reg�sired inforrrfatio�must t�subrnitted, <br /> 1nComplete apptications w+it be retumed. (Piease pnnt) <br /> GEhtEFRAL INFOi2MAT10N: -� � <br /> Jab Site Itdriress: � � D _ U��k "�� <br /> -- <br /> Wiil ttus be a Parade df Homes, Remodeiers S awcase Ho r att��r Display H e7 es (�Na <br /> !!yes,a specia!evenl permit is required wtifh Pdlictt C3epartmenf and Gity Cnurtcil eaprovat fi6 deys pr+w!n tt�e avent. ShttlVe bus sarvice wiH De <br /> re�uiied tmtess applicant demonshstes sr.Afx.ient on-site paficing Is avaitabls. P,1r�n-perm+'Ked aveRts wuf ntat i>a atlt�wea`. <br /> CONTRAC34R i APPLlC�4l�JT lN-F�-�t^}i2MAT1bN: <br /> IVame: �'1t�PC�OY'+ ��i iY�e�rj �5����CaY'� <br /> 5tate License# � Expiratitsn Oate' �? _ �_ � '�,� � <br /> Lead Certification Numb$r: � �- Expiratiort Date: <br /> (for work an homes fhat►vere carrstructed prlor ta t978 — . <br /> Phons: (�'�, - t"�.�2�- �i��� _ (ofFce} �9��..- "�'�`'q"S�..t(t _ iceN} _ <br /> _ <br /> ottlailing Adttress: , . '3 �, City� �� �t� �IP: ..�c�-�- <br /> _.__ ��- <br /> Contact Persan: � �� Applicant is: o tra Horneowner (Ckciwfine} <br /> i.__..._ -- <br /> Email andlor Fax- T. S .�� <br /> Pt�t3PEFt7Y t?V1iNER ihIFORMATiQN: ��} <br /> hiasne: "t '�"'"'� � � Ct�,��,���� Y��.,r�.� <br /> _ - <br /> Phane{day): �,, � �� <br /> Address: �GC>�?__t.�..�. =�S� City.�C",�-'�1��_.€. �i�.e^�ZlP: �S�{�.� <br /> Emait ancflor Fax __�'�i!^-423v'ti �t'f,�.+�ri i'YE GL" �f`ttx�;f.l��t.ir�'Ltri.E'.P�"� �,��f� G t b G>CJm <br /> PROJECT INFDRMA71dN: <br /> _ _ <br /> Type of?rojact: Any earth mavement may rsqu'ue <br /> ❑Doos(s} ❑Remodei Q Water Dsmage MC11MII review&permits: <br /> Minnehahe Creek Waisrshed Dislrict(MCWD) <br /> Q tA�indow{s} ❑Repair ❑Staem LSarrrage 182+�2 Ar4innefanka Bivd <br /> ❑Siding �Resto�tian �Other,(speGlfjvj I33eePhaven,l�Pd 5539'! <br /> ( Phane: 952-d?i-0580 <br /> ❑Re-roaf ❑Fire Damage I Fax: 952--471-0&�t2 <br /> C uru+rv.minnehaha�:�akorr7 � <br /> -- � <br /> 4verali P'raject Description: <br /> _ --- -_ -- --- -.._..__.... <br /> Estimated Constructio�Valuation of Project�exciudirsg land} § '�Z,(��.�dQ __ <br /> a���aca�r ACKr�c�we.�a��ns�ur: <br /> _.�___-----___ ___ ____�__.__----_ _--- <br /> Agrerss ta�,rouide atl infortnafinn rr.cc�i�irrd�r rrquastcd 6y tt�Quikiing[3epartment <br /> � Gertifies that the informatio�supplied is frue ans��comecK to ihe bost of hesther know(edga. The appiicant recognizes that they <br /> are solety responsibls for s:rbmitting a complete app�i�cation being sware tha[ttpon failura to r!o so,the siat�Ras ncs a�terr�a tive <br /> buL to reject it untii it is compiete; i <br /> � Sosna ot aN of the information that you are asked ta prpvide t�n tt�'ss applicattoe�is classifroes3 by State Saw as eitfier private ot <br /> confide�ttiai. Private data is inTortnatlon which ge.neraliy eanntst be given ta tfire putlliC bu1 ean be given ta#he subjact cst;he <br /> data. Ct3nfioerstial data is infflmia�n which gsnetalty ca»nat i�e givan t4 either the public or tfie stihjer.i�f the data. Dur <br /> purpase and infended use of this informat� is tc�annuaily update our recorcfs and records o#other governmentat agencies <br /> required 6y[aw_ If you refuse ta su the i fa ati tfie a ication m�not be issucd. <br /> Appifcanfs Signature: `_ Date: �q� �r; Z��L <br /> l.asi llpdeted: 03-07-20'I i <br /> „ __ _ __ _. __ .... ..___... <br />� � .,_.._._ �., <br />