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T -. '' �,�Zl--d 3 <br /> City of �rano <br /> I, Suilding P rmit Application fa�Mainter�ance/ Renovation <br /> windows, doors,sidin , re�rot�#, etc. <br /> e;r <br /> A�AdGa9,8&' Permii ns�nber a��/ � rJ �-- <br /> •%Q� �Q,, cn�mi aer,�N�23-oass tr��+�a: �-�9- � <br /> t! �, <br /> �;� �.�� sueerAad.ess: ��d�� <br /> �,�\ ' �'` 275q Kelley Parkway Ptan�w <br /> \\ p�'� Orono�MN 55358 <br /> �' ��,F�:� ► 3 i�7. <br /> F�fain: 9�'.a2-2 F�x: 952-2d9-4&16 w,ru�.::i oronG.mr us � <br /> This a mu4#be c�n�eied in fuuK and aR riec�rired informa6on m�be submit�t, <br /> kic appttcat#a�s wiH b�rotwnned. (Pteese priM} <br /> GENERAp,lNFORMATtON: <br /> Job Site A�ddreas: � p-:1?�}RL�W�_ tl�3T L�� <br /> Will this be a Parede of R �Show+�ase Hot�or other Disp ayl Haane? Y� o <br /> 7Y��9 I�OeC�I eV9At pen►dt ls Wr9d rYittt Pvlka�l�verfnterd and Gity Gourrdf apprwe!BO dsya pior to N�a eveeq Sttlstlie btis s6wfCe hB <br /> rsWir�Q un�s a &�M o�a paik�y is av�. Nor�perm�ed e�#s wAF rrot be eMowed. <br /> CONTFiA TOR t APPtdCAl�l IAIFORII�AT1t'�'i: <br /> Name: � y�q�-�W <br /> S'iate lJce # C 1 Q t Exp}ratlort Qate: <br /> Lead Ce ' Gation Number: Expiration Date: <br /> f1w on t�that pYlw to i978 <br /> i�twr,e: , It c�1 '2..- (��) <br /> M�ifttita f1d�d�Ss: Z,.-Svi}s.�iU t? C�tY� P: <br /> Contact P n: Apptica�Is: Nameowner a,e► <br /> Ema�an��x: --3 .C.�� ' .•5 <br /> t 0 <br /> FRDPE flWt�tE#t�l 7'lOid: <br /> N817t8: '' i'' ��i�?" � r <br /> �101i6 t� �� �� <br /> Address: �biT CitY;�''�,s''�'.l.a€� p�ZIP: <br /> Emaii an F� ��}-- t <br /> PROJE INFOROAA <br /> �Ya�� ���� <br /> p ooa(s)'' � p F'ire aamage �re�ear a <br /> �a Creelc Ur�[tis�t } <br /> ❑Re-roof,aspt�akt '� j�S6�am C►ama9e 18202 �d <br /> ❑Re-roof,ice�dar ❑WaDer'Damage ��+,i�i 5538! <br /> PhWu: 952-4T't-Q590 <br /> ❑Re-roor,omer t+a•�r► �r�s C3 cn�:t��r) F� s52-a��-ass2 <br /> �rtdow(s} � <br /> �.vww.,�,Ennetrahscre,sk.�s�a <br /> orerat�Pr�O�t Dessxiptio�► 203 <br /> Estimatec�Construction Va at ex tset� 6?.�(�jo.�- <br /> ARPttC ACKNOWLE EMENT: <br /> • t0 provide�i tequEred or requeated by the 8sriiding Depa�hner,� � <br /> • Ce�ifiea that the in 'o�supplied is true end cared to ihe he�K of hislh�knowled�. The applicarrt recogn"¢es Ymt they� <br /> b <br /> �a�saialp rssponsible submit�ng a canpiete�Gcation being aware fhat t�ors fadure to do so,the at�f has tao mative <br /> but I�1eJect�Imt�it i.5 ; <br /> � a�of the' th�t y�xt ana aslced to prowide«�4fi�s a �dassi�d by Sta�e Iew�eiU+er ' or <br /> Ef#, PtivaOa �i�(oirr�suoa wt�gerie�aliy ca�mot be���#u�c tx�t can ve�h�� ' oP u�e <br /> . cc�ftde�ial is i�tormation wi�Cn gener�ly cannot bs given�e�tcex the�c or th.�jeCE cd e,e . ow <br /> arnf Nt�a��ded afi tltis Iitiom�on�La atxul8�y t�date au�rec�'ds a►�ci records at�9ow�tal � <br /> i8w. t tlte trra r�be�ted. __.. <br /> Applican�s',Signature: Date: . �"'� /" � <br /> �astuv�+�:�1 os�s-2o�t <br />