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i <br /> � . s � <br /> c�ty �f a�o�� <br /> Bu�lding Permit�ippli�ation for in#ernal 1Nar1� <br /> {windaws, dcfors}siding, re-roo#��atc.} <br /> ' .¢t,�,,,� ILi'o Bo�ic�G. ' , F'err+ntY n�xn�sr: ' ' l <br /> � Cry�tat Balc.AqN 55313-0U66 i�e rec�e�f: _�-/ � <br /> � , " Sfiset Addnesst �l�eeivetf by' <br /> �tg��.'a�' 20raw,MN 55356 y Plan raview fee: <br /> ' _= ToiHt F�e: � � cl J. �r � ' <br /> M�n �'i2-2�9�6t]0 �s�c 952 249-4616 wvwv.ci.oro�so.rr�►� / <br /> Th ap�plicatitrn ftu�rt tnust b�comP�eted�i�artd a{I t�}uineri i�xsrmatbn must be subrnittsd.' <br /> M�omPiete�iieatiot�#'wiN 6a t�trt�wed. {f�fesse prir�t� ' <br /> GENERAL INI ATION: � r 1�i Q <br /> Job Si�e Addt�s : � <br /> YlNN this be a Pa of Homes,Rema�d�l� �i r otl►e�C?i�Y H' _ ? es Na <br /> ►ry�es,asp�c►+f Pem�Jtlsreqtdr+edwd'hPb►dcsOeyarfinentandGK}+�ap�pr+ovalQOr�ysprkirttrdrea�t Shuttlebus�e '►vNlbe <br /> req�d w►Aass ap�lce�rt dem�s su�+eient on�.slEe parkirrgls aueiia!►Je. Nbwt�varrrrt6�d even�w�nod bs alloWect. <br /> CONTRAG70R 1'' �PUCANT INFOR�ilATIaN: <br /> Name: �.1a��OT�. � . <br /> State Lieet�Se# E�itation Eiate: .. <br /> Lead Certitication Numbar: �} �a�rcation�te- <br /> �+w wo,r�C on lhst,wra pnk�r�a 1�T8 <br /> Phane: ta 3- (a�) ��.- �'�"' Z-Cf (celi} <br /> AA�iirrg Address: , ;� ZIP: <br /> Contact Persorr: Applicant i.�: tra r Hr�rn�oumer cw�.o�.� ' <br /> ____ <br /> Emai!and/or Fax: '' ` „ <br /> PRdPER7Y ER INFORMATIC�N: ' <br /> I�m�. � � s� �'.v�."� <br /> Phcxie(day}: , , <br /> Addcess: ��2_Q t.c.7�, '#'� -j�' C' . _ ZIP: ��,ts <br /> Ema��ndlor Fax . � G' ., <br /> PRQJE�7'INF RMAT'ION'r <br /> type of Prol� ' A�r Ra�ih mew�twnt may inp <br /> p ooa(s) Q Re�de� [�water o�na�e McwD nevi�w 8 per,nit�' <br /> Mint�aha Cre�c W�srst�d Di (t�Af;WD) <br /> [p'Windnw{s) ❑Repair p stcsrm Dsama�e 1820"1 t►�ru+r�tonka Blxd <br /> �Siding �RastcNatlon ❑8ther:(specFiYl , DeeRha�nen.NN 55�1 <br /> [�Re-rcanf [7 Fire Da Photta� 952-�#7i-U�90 <br /> L7 me�e Fax: �,z-a7l-ossz <br /> GArerait P �t •p�+on; � . <br /> Est�matwd G ctian Yahr�ion of Pna ex+atudtng Fand} , ; <br /> APPL,iCANT AG, N4Wt.EDGE#AENT: <br /> _�::__. <br /> Agt+ees to ` vide eN infcxmatian�equitsd or reyuestdi by tl�e�uiklir�g Departmen� _ <br /> � Ce►tili+ss t the irdorr►,�ti�suppliHd is tn�e and caract po the be�oi hiather knawled�. 7ne appAcant r�i�g ' tltiat they <br /> are sdely pcxtsible ic�r sub�tting a cnmpie�applicatbn being�rware tl+aC up�n fallurB�da so,the sfafl t►as no sNernati�ne <br /> httt io te it ur�lii i[is compl�e; <br /> � s�ane or�� a�f ine mf�tion rhat you ara a�red ta provids on mis appficscinr�is dassi�by st$te law as • �pri►►ete or <br /> cusnAdenUai P►lvata data is�tfanlsU�which:9ene►aftY cannot'be git�ert to the p�lic bt�can 6e gMsn ta tl�e of the <br /> d�1ta. entiel data ia iMam�ation ufiidt$enerally'camat--be givan 1a e3tfier tF�e pub�c or the subjed� data. Otx <br /> P�rpose inGEnded tase of tt�infomtaitaf �'�8tutiuslgr upd8te ow'�ds and�ecords t�f other' rttsi a�ncies <br /> uired . N refiase ' ' �e "_ �on�r not be issuad. <br /> Applicant's Signat re_ Date� � Z <br /> tast UPdet6d: 03-fYt= 11 <br />