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� �-, � i <br /> City of t}rono <br /> ; Building Rerm�t Appl[cetion fcfr Maintenance / �ienovat�o <br /> windows, door�s, sidin�, re-roof, etc. <br /> ���y MairRO B�ox 66� Permit number. �� <br /> J O i �Ya� G►Yysta�BeY.MN 55323-0068 t)ate received: �/ <br /> �i'� �,i1 sveer aadrgss: Ftece;ved by: <br /> :g�^U Orcu�o,MIN 5356 y �ew fee: --- <br /> � Adein: 962-249-d800 Fa�c: 952-249-4616 w�nu_ci.orana.mn.us � � �` �r� � <br /> c <br /> This appiicatian form rnust be com�eked in full and aN required information must be s —� <br /> GENERY#L tNFORMAi1�N: tncomple�appllcations wili!�e�etumed. (Pleese pdnt) <br /> .fob S#�Adctr�,a: �..�.���1-1-'g`� P��.Kta1�A`aC.— ..[1�37 !�Y <br /> �It thi8 ba e Para�of#iames,Remo�feleia Showcase tfome airather Disp�iay i�lame7 Yes No <br /> !f yoaJ e apeWal6vaM pemrlf!s raqudred wiYh Adke 4�artmer�and City Counc�approvel BO daya prnx to the evar� Shultlb twa a+b be <br /> � ,eQwroa uMass epplrcanr demorrsastes auntcient ar-s�te parkirrg fs ava�abAe. IYa,-pam,i�ed ev�nrs wiu nor be aun <br /> COIdTWACTQit/�4!'PUGAN7'IMFORMATI�i: <br /> Nsme: � #Wt +.t TYLcaC'�"�/ <br /> State�ense# ��,ier��Q�, { Expira�on Date: <br /> Lead C�rtifica�on Nurnber: ��� � Expiration Date: � <br /> (far wark on homes tl►at wm�e cotr�tructsd pNor to 1978 <br /> Phane:' .._ � (affrce) �.- 1 - '� (ceN) <br /> MaNing�Address: 2-Sv��. Zc�o CitY: P: <br /> Contac�Person: , : Applicarrt is: acto Hvmeowner �c�.a,.� <br /> Emai!ajnd/ar Fax: ,,.,,�- � . � p r> <br /> PROP�RTY OWNER INFOl26/ATiON: <br /> Name:, t� r�Y7 # -r� a�v <br /> Phone�daYa� �t 52-R t 5- "}- <br /> AddtesS: ,S�3Q City:�T.l.o� �.r�ZIP: <br /> Emaii�ndtor Fax �q - <br /> RROJI CT INFORMAl7QN: ' <br /> TYPQ P��t: Mp earth mavelmart �eQuiro <br /> ❑Do�(s? ❑t2emodel #,]F'�8 Damage MCWD�N$ <br /> mm��snane c.�w�a �� cn�c�r) <br /> ❑Re-�pof,asPhait �Repair ❑S4orm Damage 182U211+�nnetatka <br /> ❑Re-�oof,cedar ❑F2estoration �Wate►Damage ��Pf'�g�+,MN 4 <br /> Phone: 952-471-QS <br /> ❑F2e-#oof,oth�4�PeG►fY) ❑Sidin9 Q f�her.(spsWfY) Fau: 952-+tTt-068 <br /> �����$} www.minneh�s <br /> t?�reraii Projact Description: f',�rV.;3N VJV2? 2oY -- <br /> —__,_ � _._ _ <br /> Estim�tcd Canstruction YaJuation of Praject(excludtng land) 2 C90a,=-' - <br /> _ _ /� <br /> ARPUCAIdT ACKNOYVLE�C'+EMEN7: <br /> • ! �r�s to provtde all irdormaUon ree�eined�requested tryUie BWiding 13eVartrne� <br /> • � Certifies that the infortnstion suppiieti is We and corteect to the best of his/het knowledge. The applitsar�t nize.s M�at they <br /> ! �e saiely responsibte fctr submilting a corr►piete a�lication beiag aware thai upnn failure to da so,fhe has no akemative <br /> ! txli t0 rejBCt it ut�til it b Complete: <br /> • � 3ome or etI of the it�fottnatiart thet you aro asked to provide an tlris appiicatlon is dassified by S#ete law either private or <br /> canfidential. Private de�is irTform�tton which generaily cannot be give►r tc the public but can be ghttn �e sutaject of the <br /> � c�ta. CoMidertfi8l data is inf�m8#iaR whiCh generaCly cannot be g'rven to ei�her the pubNc or the subj of the dafa. �r <br /> purpose�nd intencSed use of i11is k�formatlon is to annuaily update vur records snd rec:wds ot�her g ent�agencies <br /> ired law. u.reft�e ' Qte kat�n rr�a not be i�ued. <br /> �pu�rs s���,�: o�: � `/ 9 Z,a�3 <br /> ►.as�uqea�: os-os-zo„ <br /> � <br />