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r <br /> . � ,/�� � � <br /> ��- �9 a�- <br /> ,y / <br /> . �-�a , <br /> c��y of orono . <br /> 8uilding Per it Appilcattan for Matntenanc$/Renovation <br /> wlndows,doors, sidtng,re.roof,eta. <br /> MallingAddreas; pemtilaumber. 0�0l,(�— � 95 <br /> . 0•�, I,j�.� PO Bnx 60 <br /> Cryelal 8ay,MN 66323�q088 Aate raaelved; —� �O'— <br /> 5treet qddrass: Reeetved by: <br /> � o��� Orono,MN 66368 ay • p�an revlew fee: <br /> Maln: 9S2 248-A8D0 Fsx: 957r248�q816 Total Fee; <br /> � This applicalfan io must be compieled In tull and�II roquired Intormatlon muat be submftte . <br /> 1 aampleto applioatlahe will he retur�ed. (Please prinlJ <br /> (��N�RAL INFOl2MATION: <br /> Jab SiteAddreae; 2. It� 2i1 Z- <br /> Will this be a PAreda of Hame� Remode era Bhowoag� oma or other Dleplay Home? ea j � o <br /> If yes,e spaci�l evenf permit ts roqu d lvilh poNao DopP►fmsnt Obd OfW�undlnpprova!60 deye prlqrlu tha evant.ShuHfo bus ebMoo wpl ba <br /> roqulred untea9 appl7oah demonalretes aulpolant oaalte parkGig/s aya►1a6/e. Non�,emdffedevente wlll nol4e e(lowad, <br /> CONTRAGI'OR/APPLIQANT I �pF2MATl9Nt <br /> �lame: � G' o►� <br /> 8tata Licansp# G, � ( - BxplreUon p�ta: <br /> l.ead Certiflaaqon Number. /M.- Expl�Uon Date: <br /> (for wark b»homes th�t were n�(ru�ed pr ar to 9� <br /> Phone: .(office) ca0) <br /> Melling Address; 7..� 'ti 2a o �nY� �p� <br /> Confact Pereon: Applicant ls: ac or / Homeowner tcirca.an�1 <br /> �mell and/orFex; r- �'► S <br /> p�OPERTY iDWNER INFORM IONt � <br /> Namac i ' , <br /> Phona{day): �t5 - City: ,LD b+t21P� <br /> � Addraes: ' b0 <br /> �mail end/or�ax <br /> pROJ�CT IA1FbRMA'f1oN: <br /> rype af projedt: Ar+y uarth movament msy raqutre <br /> MGWD revteW&permils; <br /> (�paar(s) i O R odel Q Flce pemaga Mlnnahahn Creek Walerahed Disirint(MCWP) <br /> ❑Ra-root,as�hait ❑R air �i&tonn dama8o 1e202 Mlnnetonka 8Nd <br /> beaphaven,MN �6881 <br /> ❑Re-tpof,cedar �)R torallon Q Water pam@ga phone: 952�47i•0680 <br /> ❑Re•ronf,othor ppoolry) ❑st �n� O o�hec:(epootry) �ex; BB2-471-0882 <br /> }wn�t minnehahaaraek.ora <br /> • � . _ p w dowc�r <br /> Ovarall Pralepf Dascriptlon: �v��5� +N�*��'r� S� <br /> �$timated G nsfru�tinn Valu ion atPro eat exaludln IapA 7�2�00 `''`� <br /> APPLICANT CKNAWl.ED EM�NT: <br /> • Agreesltp provide ell tnfo tlon reputred orrequealed by fhe Buliding pepartment; <br /> . Cerlifle ihat the Informsli supplfed Is ttue and correot to lhe bast ot hTs/her knovAodee. 'fhe eppUoent recognlzea ihat 1h <br /> are aol�ly reaponalble tor bmil�q9 e complele eppliCdllo�l baing awere ihat upon fatlure to do eo,iha etalf hae na elterndq <br /> but to rqJeot It unUl it la oo lete; <br /> . 8vmea�all of tho Inform lon lhet you ero eakcd lo provida on this eppltcalfon Is classHiad by Stata law es olther pdvate r <br /> oanOde�lAeL private dala e ln�v►matlon whtch�enerelly oannot be given to ihe publlo but cen ha givan(n lhe subJect o(Ih <br /> ' data. CronfldenUal dat�I �nfatmalion whioh 8enaraNy oannot bs siven�o et�her the puWlo tir the subJeot of 1he data, 0 r <br /> purpoael end Intendsd ue of Ihls informallon Is lo annually update our recarda and recards of nther povammantel agend <br /> re u�e b law. If ou ref e t 1 e fo �aU ,ihe a ItcaBon ot be Issued. <br /> ' . AppltoanYsslgr�ati�ra: uste: ,_.�'�y���' <br /> : ' LRstUpdeled:09�9•101t � .� � — f �` �� <br /> • I ���� <br /> ' i <br />