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, ,�� <br /> Clty af Orona , <br /> Buildin� Permit App�ication for tnter�ral Work <br /> {windows, doors, siding, re-roof, etc.} <br /> —� Mailing Address_ �n /2_�� <br /> ��,�,�. PO Box 66 P�mi#number. �W�1 �J <br /> (� (!}� Crystai Bay,MN 55323-{7� Date received: ��7�//� <br /> +1.�� �r•'" a, ( Street Address: Rr�eivec�by: ="�7— <br /> � .�, G��'f 2750 KeNey Parkway � Rlan reyiew#�e: � 'r �;� �L', <br /> � <br /> Oron0.MN 55356 <br /> ��`y?r�ra�,� _ <br /> - -- � Total Fea� � ,-� ��� . � / � <br /> Main: 352-2d9-4&d6 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This appiicafion form must be campleted in fuit and ati required i�[�rmatian must be subrnitted. <br /> 1�camptete applicatians vuiil tse retumed. jPtease prrnt) <br /> GENERAL INFOE7MATION: y� (i /' -t- n ( �_ J ^�� <br /> JAb Site Addrass: _�.(n�C� K-P..41� �ft.('�,�'TtL.A ( �t�►'�2.�U L'f?Yk.Cth �Y11 T 4.�,__� <br /> Will this he a Parade mf Homes, Remodelers S owcase Hom r ather Dispiay Hoh►s7 �'�'es �Mo <br /> JI yos,a sp�cie�avent permit;s mquind wt[h PoFice De�arhnerrt�r�d Gity Cour�J approvat 6Q days p�iar to tha evarti. Shutlt��$service wr(�be <br /> rnqulred unless appJrcant dernorrstrates sertticient on�ite per�ring!s avai�841e. Nr�r+pemritfed events w�!nat be atlowc�d. <br /> CdNFRACTfJR 1 APPUCANT!N-F-�{)^RMAT)QJd: -;� .�. <br /> Name: �.'la�e�4�.JC.iVYR�� �S��'�WC.�L t¢�Y� <br /> state�icense# ��s-���,�4 � Expiration Qate: �_ �.. � �„ <br /> Lead Certificatian Number: j`}�}�.. Expiration Date; <br /> (for work on hames l�hat ryere coastructed prrar fo t978 <br /> Phane: �'2cl_ �(��_ (aifice3_ (�i 2" • 'g� "32..�4`� 1'��) <br /> -----__ <br /> Mailing Address: . . � City .�+c ._�Gct✓ti 21P: ���-�-c� <br /> __._.-- -- — <br /> Contact Person: � Appiicant is: n tra r Homeowner �c��o�} <br /> Emait and/or Fax: <br /> PRQPERTY OWNER INFQRMATIQN: ,, _ _ � -(� <br /> Narne: ��,,�y�,�t �t�r''.�.ir�.� __ <br /> �"�t,�^`�. �..h +a E'..�n.rt' <br /> Phone(day): Z, + <br /> aaarEss: c d�n �. 3 6��� c�ty�i���, zr�: ,�� �{1,l� <br /> Email and/or Fax � <br /> _.- v, <br /> PROJECT{NFCIRMATION: <br /> — �_...--- - <br /> Type of Project: prry Fart►r mewement may require <br /> ❑Door(s} �f2emodel ❑Water Darnage ���Q��ew 8 permits: <br /> Minnehaha Creek Watershecf District(MCWD} <br /> [�Window(s) � ❑R�pair ❑$torm Damage � 182021utinnetonka BNd <br /> �Siding ' ❑Restaration ❑ather:(spectfy) � �1eeP�aven,MN 55391 <br /> � Phone' 952-471-0590 <br /> ❑Re-roaf ❑Fire Qamage Fax: 952-•t71-d682 <br /> � wfww.mirtnehaha�reek.aro � <br /> Qverali Project Description: , ' ,, p. '" <br /> Estimated Gonstructfon Valuation af Project(exalading iattd) � ; `:--�- <br /> APPLICaNT ACKMOWLEDGEMENT: <br /> ______ ____ <br /> Agrees to provids aii infomiatian required or requested by tha Building Departmen� � <br /> , Certifies that the informatiari supplied is true and c�rrect to tt►e best af hisfher knowledge. 7he appltcant r�cognizes that ihey <br /> are sotefy rnsponsible far sutrmitting a comptete appiicatlon be►ng aware�at upon faiture to do so,ttie staff has no aftemative <br /> but to reject it unti!rt is compl�e; <br /> � Some or a14 af trie informalion that you are askad to provide on this app�caUon is ctacsifisd by Stste taw as either private or <br /> confidentiat. Private data is information which ganar�lfp cannot 4e given to the pubfic bui can 6e given to the subject of the <br /> data. Confidentia{ data is information which generalry cannat be given to either the public or the suhject of the data, Our <br /> purposP and intended use of tnis information is to annually update our records and reCords of othef gOVErnment2l agencies I <br /> re uired b law. If you refuse su the ii ormation,the appttcation may not be isscied. ( <br /> ApplicanYs 5i nature: � �� � __ oate: �,, <br /> 9 t~' ����t � <br /> E.asi Updated: 03-01-26i i <br /> �.._.._._—_�_.�. <br />