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---�--_ .. ... . <br /> ,, , <br /> � ,: , <br /> , , <br /> II <br /> +�ity t�f t3ron+� � <br /> 8uilding Permit Apptic�tian for in#�r��� V!I�or1c <br /> {windows,cioors, sid�ng, re-roof, �tc.} ' <br /> _ . . <br /> -�=`- I l�d°'!'"gA°i�1`nsa: �it.twnaar l _D <br /> �� PO Box 68 <br /> Q � ���lf�MN 55323-�066 D�e ren�ive�: —/ —/ <br /> S(reet Addr+ess: �� <br /> � ��, 2750 KsMeY�Y Plen reY�r <br /> Or+arto,Ml�i>�'i3� <br /> _ �. ,���� i a ,o� <br /> 'n: 952-��9-46�OQ Fax: 952 2-08-4816 urww.ci.cxnnq.rru�� <br /> fiis appiication ft�r�t must be aompieted as f�and�ii requk+�d fa�forrnetjo�n must be subrni <br /> ; incompiete a�sl{eatfans wiN be retumed. (l�lesse print) . <br /> ���ter��ir��nnanot+�: <br /> .�as s�aa��: � � i <br /> Wia this be a �ade ot Homes�,Remad�lars ow�casa N" c Display'H 7' e� No <br /> , <br /> K yAs,a f swnt pomtlt ls n�ived w�tlr P`4l'�tle�osr#m�►M a»d"�yl��pproud►8(tdays ptfor to!ha avbM. ShtA�e �w�l be <br /> re�ligd untess app!lcar#d�monstrrites au�ciax on�e pa+kingls a�e. lJon�errrrtttad eveMts w�f not be <br /> CONTRACTOit t NF�F�'+UCANT INF RM1IATION: A <br /> Name: C:1D�"`��'s � <br /> > <br /> State Lfeense� ExpKation f3ate: .. _ <br /> L.�ad GertitRcat�on hlumbet: � Expiration i3ate. <br /> �or wertr on;dwr,es u+ar woer+.consteue�t p�m isTa <br /> Phonei �,. ; {office} ' ��.• �$�" Z[.� , icel� <br /> M�ling Addres�: . . `�' :�► �� <br /> Contmet P�rstarl: • `. Applicartt is: Homeowrte �cw�d�on�) <br /> Email and/tx F�x: ' � <br /> PRQPER'iY OYYNER iNEt}RMAT10Fi: '' <br /> Name: 't"` ,� �,"�' <br /> Phone(day): I , <br /> Address: W. "�'k -t" C' . ZIP: L{t.� <br /> Ema�and/or F�x ' ' . . <br /> PROJECT 1N�t�F'tMAT1UN: <br /> Type qf Pral!� 'Any aar�f�M ma�/ we <br /> IIACWLI e�vleW d4 p�arm : <br /> D oo��s> ; D Renwdel'' D wacer�: r�u�►�c�xw�e+snea ' (r�rvay <br /> p wr►�w(s} ; p t3e�i� D stomn oemaga 182�tw�etor#s BI' <br /> Q 5iding ❑iiastoratian ❑C3tt�:{spec[fy} D�Ahaven,MJ 5,53 1 <br /> � Photae: 952-A71 <br /> ' p Ra-rao� ' CI Ftre t�amage F� es�2�F7�-ass� <br /> , k <br /> Chrersit Pr ect Descri�tton: '� <br /> Estwnatad G c�ntctioa V��aiion af Phro'` �uccluding iand} ; --'^� <br /> A�P�fC�4t�TT KNCWLEDGEMENT: <br /> 1��es td pcovide sq inficxmatt�t�required or nequested by tha 8�1��9 De�aRme� <br /> s, CerqTin that'd�e it�ocmati+�suppfied�true and ca'rect t�o flre best of hf�he�'kr�ledge. 77te apP�ScK_ ' Mint Chey <br /> aca�responsible tor submitta�g a c�np►�appltcatbn bBhag aur�re�at upon faiiu�e to cb so.the stafF tw ai�mati+;� <br /> dut to re it ttr�l it is:campiete; <br /> � Same ail of�infamstion tl�t you�ue eslEed Ln Provkfs art tt��tlon�;,ct�sided by Stets law as a�lt�ptivate cN <br /> oonfide�. Piivste data is intormatia,;wnich ger+e►�r cannot be giver►to ths rx�C b�can tse�ven to suk�t c�the <br /> da#a. CbrKid�Nai�te is ir�nt�ion which qaneraiN cat�tot i�giver�to sitE�er'the pubiic or the subjec3 the data, tk�' <br /> purpose�d irtterded use csf fh�s in�on#�annua�yt updswa otv►ecords auux�cecords o�ott�ec� ntet eg�ies <br /> r ' ired ISw. ff reft� , {!�i . . fit�r►rrya nOt b+e issued. <br /> ppplicant's'Sign�tura: DaLe: � �� '_ <br /> tast Ua�ea: o3-a1-2qrt <br /> � <br /> � , <br /> _... .. .. ' . �_.._ '_. �_.__.__.__._ ._.. _ <br /> li , <br /> ' I <br />