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. � ,....... _ __ <br /> C't�y �f +C3rc�no <br /> 8uitd�n� P�rm�# Applicati�n for Internal Vllork <br /> , <br /> (vvindaws, doorst sid�ng, re-roof, e#c.) <br /> /.,�,+Q�,, '�`�� Penn�rn�naer. o�! = L71� <br /> j c�y�+sav,�u���-ooss'' oats��a: � / - '7 �v1 , <br /> � p <br /> a� s. SfrBetAddress: Received by' <br /> � �' 2750 KeMey PaAnaray Plar�rayiew <br /> �'� �� thono�futN'S5356 <br /> 4=r-'"' Total Fee: �/ <br /> Ma" : 952-2d9-4800 Fax: 952-249-4816 www.ci.ora�a:rnn.us //��"tt'`/ <br /> T is appUcation forn►m�t be comp�ted in tuli er�d�il re,tauired informaikm must be submttted. <br /> incomptete appiicatians will ba r�tumed. jPlease prinfj <br /> GENERAL INFQRMATION: � � g�f 1 ,�,��,/ <br /> Jab Si�e Addr�$: (./ T t� <br /> Will tMis 6e a rade of Homes,Remadelers owcase H r' Display FI s? es o <br /> If Yes�a sP�+a eve�Pemdt!s required'wlftr PoNee DePBRnrsnt e�d Gty Caurxx:�f approval 60 cfays prf4r to ths ever+E. S�trtNe bus s ' wA!be <br /> lred unless appA�caN detrnrutrates suNfcienf on-s�e:parking fs availalrle. Nwy-pem+iaed evoe�+�'not bs a/bwed. <br /> caN��acTo�i a��u�ar�r iwFa�x�+aTic�►�: <br /> Name: �'la�'r.�or. e. - �. <br /> 6tate License#I �0 5'��'0L�t ___ Expiratipn Date: «. .. <br /> LeBd Certificatidn Numbar' (���t}- Expication Dat�e: <br /> (tor work o»I�ames 2Aat ar�rv cattstrttciQd;Prtar ta l�TB <br /> Phone: L�3- tof�ice) 1 2• �'",�- Z.� {cell} <br /> Ce <br /> Mailing Addres�: Gity ���_ ;,�'Z�CP: <br /> • .,..... <br /> Contact Persai . ,4pEylicant is: fra Homeowner cr�a�� <br /> Email�ndGor F�x: • _ , <br /> RRUPERTY O�ER MytF-p-.RMAT10N: �-�-�+ },. <br /> Nams' ,�'L {�,'�c L'�'�-� .�^ !'1�� Ei�."'�' ,r'..f..,,. <br /> �....�....._. <br /> Phane(day): �z�,�.l��^��'_���. <br /> Address. � uJ. 3 `�°' �' City. ' ZIP: �{jb <br /> Emaif andlo�F�x ^}_� <br /> � . -- _ � _ . . � <br /> 'PROJEGT IN �RMATION: ' <br /> _...__... <br /> Type af ProJect: Any earth rnowemet�t rs�ay re uire <br /> ❑boorjs) ❑Remodal ❑Water Ramage �GWD r8v(sw l�peRnits <br /> RAinnr_hah�Creek Watershed Disf' {MGW D) <br /> ❑Window(s) � ❑Repair ❑Storm Damage 1820�[a�nnetankaBivd <br /> ❑Siding ❑Restoration ❑Odd'�er,{sp8cify) ��ePM�en,MN 5539'f <br /> � e Phone: 852-471-0580 '��� <br /> �Re-roof ❑Fire Demage Fax: 852-471-Q682 <br /> acreek. <br /> overa�l Proja Desc,iptlan: ,x �i tlx:1� <br /> Eat�►7►ate+d Ga sbv+�tion Va#uatbn of Projeck excluding tandj $ (� <br /> APPLICANT I�N�WLEDGEMENT: <br /> Ag+�ees o provid�all ictfurtnaiion�equired a�requested by ifie B�ikiing C�tairlmeE��; __� <br /> i Ce ' tt�t ihe informatic�aupplied is true and aorre.ct ta Ihe best of�ther kno�rfed�. The appl'�ant " Yhat they <br /> are�I responside fa submiuin9��P��aPRticati�n being awae��,at upon failure to do so.the staif ha na alternative ' <br /> but m it urtitit it is comp�te; <br /> � Same dr a!4 of the informatiesn that yau are asked to provide on.this apptfcsgo��c�ssi6ed by Stste iaw as ther p€ivate ar <br /> can5 6ai. Priva#e data is information wtdc�g�►erally rannot be given to '. but can he given ta subjeet of tt►e <br /> daia.�����Rdentlal data is irsformaUon whidi generat[y cannot 6e�iven to e ��# , public w fhe subject of e data. Our <br /> pu and interrded use ot ihis infarmatiott is to annually update r�uc � reeorda of athe�govem �t�agencies <br /> re �re 6 law. If u refu&e i t ir�f the a ticatlon�ltta nc►ts <br /> F <br /> Applicant's Sig ature: b Qate: _� C�! <br /> Last Updated: 03-¢31'-1011 <br /> � <br /> � <br /> _ ......... � _ _ ._ _ ._.._� ....._._.��_� <br />