Laserfiche WebLink
. .......y . �� . � . . . . .. ... <br /> _ ._.—._. <br /> � CI'�/ ti"� �'t�t'ti <br /> � Building Perrnit Applica�lan #��- Interrtal Work <br /> W�t1iaV�rit! �V�V��, S�� E !�'�� @LVa} <br /> A,fer7ingAddr+sss P8R1AIfttu»bet: / — 9 <br /> ��' .,�� P'�,&�x 6G ' <br /> Crystai BsY,MN 55323-Q066 Dete received: —/ — <br /> a� p. S�ret Aa�res� Re�by: <br /> � p'�` ����Y��Y f'!S(1 T91tiBW fe8: h/ <br /> Ororw,MN�5356 j� <br /> ��... TWai Fee: p��Q, (J� <br /> M�t: 952 249=4�0(3 Fa�e 852-+249-46`i6 <br /> ThIS�t�tOR fOtCr1 tTtUBt k1B i:txiiD�Bf87d�fl�'Sttd i��'9d i[{ftXm3ti0tf tt7i�t bEs It�f. <br /> �ICOt�tp�@#@�11C�OItS 1M��1i8(�UCti�. [/�SSB�1f}!i{� <br /> ti�1ERA�.IA�ORMATION: y / <br /> Jo�b Site JI►dd�pss: S_ '�' 1p <br /> Wiil this s Parade of H�,Romodalar� ass r ti�r OispFay H 7 No <br /> M yea,a s�nt verrrYt�a�yui�at wrtn Pt�ce•p�ar�er�tand�rCo�mcxa�rr�r 6o da�rs piorw rhe:evam. bue sendi�wPl ba <br /> neqUtred rmJess a}�1car�E�iemor�a sratrcierlf'ewr+aite park3r�1s aveF�ie. Non-pa«7eittetf etier�s wl�tuit be <br /> ' CONTR�T'UR/A��' LtGANT IN�QRI�AAT[QN: <br /> Neme: t...11ts!`c�' � y'� <br /> State'Llc:e�8# Ex�on'Date: � -- "�►,.... <br /> Lead CertificaCuon Number: � !t'�.. Expicatfan[lat+�: <br /> (forwo�c on homar�wws ca+�ruc(�p►!orlb tlFTB <br /> PrtOne: C��' - (off�ce) ��` �'"$'Q— (Ceii} <br /> Mailing At�lr�ss: . . Cit�' :,�, p; <br /> Gontact Person: � Appiicant is: Hame er tc�.o�.� <br /> Emaif and1cx Fax: ` <br /> PROF' O�MtNER.IlsIFt?RN1�T{QN: <br /> Name'� � � t't � �in.�' <br /> Phane(da;�r): ; - � <br /> a��r�: � ' �-t�,� w. 3� . 5`fi' �+�►• , . , P: ��� ' <br /> Ema�at�lor Fax c�. G` •C�rv� <br /> PROJEGIP IMFt9RMAT1L�1: <br /> Type ot P�J�ac� _ Any�artt�mo�ent may requ�e <br /> ❑Door(s) ❑Remadel ❑{�lfater Qsmsge MCiiYD revi�wr 6 . rntifts: <br /> i►�inn�hai�Cre+e�c Wa�s Dbtrict(MGW D) <br /> p win�r�s) ❑Repair ❑stmm D�nage < 18?A2 tu�aneton Btvd <br /> p siang ❑RestcNatio►, C7+ocf,er:tsc�eGAr� �ave�,,ru�i 553s� <br /> Phune� 95,2-47 -fl590 <br /> Q 12�-roof l ❑Fkre DemBge Fax: 952-471 <br /> __._. _ <br /> QvsraH P �c�#ioscwiption: ' _--...__ <br /> , <br /> Es ConsteucNon Vs��tian of Pra' ex s .-� <br /> ' APPLICAt+1T A�KNOWLEDGEII�ENT. <br /> A�io provid�all;nfwrnation require.d or r+�luested bY fhe Bu�din9 DePartrt►e►� <br /> � Ce �the iniprmation auppfied is-trues a�correct to�t best�!�!#�krwwledge. ThEa recog�izes that they <br /> are sdety[espoasible i�sub�flting a c�rnple�applfcaiion b�ng aware Utat upttr+f;�Nuro to do so;th� has no aaemative <br /> 6ut�to'eject it ut�3t is cattpie6B; <br /> � Sat►a ar ail af the tr�fot�atiorr tihai y�ou,�e�ked�n provic3e an�appGc�or►is+dassifrmd 6y St�te as�her private� <br /> entisk. Prh►ate data is h�fc�c�tratla�wtdc�generally t�rsnoR be#�iven ta ihe pt�bliC txA can he ta the Sub}eri of#he <br /> w <br /> d . Canfidential�ta is irr6or�realbn tirfiich 9er�er�y camat bs�v,arr ti�eitl�er tFis puWic ar ihs ect>af the t�a. U�u <br /> �ir�tentle�use�f�is in� is to annitsily�!e'ke c�tr�rtis snd r�rds�a�h� '`agenci8s <br /> ired Fitiu. if rotuse the ir�atmatior� ths �on not be i�uedC <br /> Applicant's Signature: pa�• 1��� <br /> last UpdB[�:!83-41-2011 <br /> �_._._�__. �...... _..� , _.._... _ __. <br /> � <br /> I <br />