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i <br /> � . '� ._ . r�_ �-�� <br /> C�ty of C3rona <br /> � Bu�ldint� Pe it Application for Ma�ntenance I R nov�tion <br /> v�ndows, doors, siding, re-roaf, etc.) <br /> i .¢,p,�. "�'n��. P�� : a0l� - 53. <br /> � p ���a,,,ann��3-ooss ��. - co—t —l 'J <br /> � 8fieet/1dd!'�ss: Received hy: �Y'�/l ' <br /> � ,� 2750 KslEey Pmtitway Piatt review <br /> 4` Orono,MN 55366 ' <br /> T�►��: � � ! g�,� <br /> Mairi: 952-2A9�4600 Fax: 952-34J-4616 unvra.ci.orono.mn_�!s <br /> Ttils a ir�tion <br /> ppi r mt,rst be bed in full and aN " <br /> c�omple rec�ta'ed�nFonnation must . <br /> � comptete appticattons w1N be rewmed. (Please prfnf) <br /> I GEt�ERRL 1NFUFiMATtON: <br /> Job Site Acfdress: 2 .��� <br /> i VlFili this be a Parade of Han Remodelers 3l�owcase Home or ofF�er DFspiay Home? Yes Mo <br /> Ji yes.e speclal event perr�dt Is wkJr RoXCer laqw�tr+ent and C�y Cowx�eppmv�t 80 areys�x�w to t!re . ShutUe bus ae�vhaa wi�be <br /> reqc+fred tmiess�l demon�etes�raRent atslte parkfig is sw�dlabte. Newx.p�ted e+ronts rrot be a!h»sd. <br /> I CONTRACTOR!APPUCAWT i FORMATtt'�{�i: <br /> IIYame: '�"�FiF'i G �J S Ytc?G"'F�pr�/ <br /> State License# �, 1 j Expiration Date Zp <br /> j Lead Certification Number. Expiratiai Dat� <br /> (/vr work at ttotn�r�t►vere ucied ptior fo t�78 <br /> I PhO�}@: _ � (t7�Ge} 2'7i� 'Z ��� <br /> �Mailing Address: -Su�hr. Z-u o �= {' P: <br /> I ContaCt Perso+t: Rpptit;arrt is: cBDr t�meawrte[ �aa a►e> <br /> I Email and/or Faac: . v�s r c�,. <br /> PROPERTY OWN�R INfrrpRR . <br /> IfVame: h3 . r ' e4? #�l�in7�. "ToLr'�t/�-t'v <br /> Phone(daY)= 'ctS - • <br /> ��ddress: SDa -� �r-5t•w►�ss ,��rzE�: <br /> IEmai[and1�Fax �q : <br /> RQJECT INFQRMATIQN: <br /> ype of Proj+sct: Anp earth rt�y requ�r�a <br /> �]Door(s) ❑ ei [��re Damage ��� ���' <br /> Re-roof.asPhait ❑ ir M�nehaha Creek E7IstFiCt(MCWD) <br /> ❑Stortn Damaige 18202' netonka BNd <br /> �7 Re-roof,eedar ❑R tion ❑Water Damage .k{N 55381 <br /> Fh[xME: -4T9-8590 <br /> �Re-raor.on�ar t� ❑ �9 D omer:Es�ecitv) Fax: -a��-oss2 <br /> � ��5� minn s <br /> erail ct D�cription: 3i�' <br /> stimated Gonatrtr�ion Val on of Project exdudi�g iand) � ��qZ.= <br /> LICANT ACKNOYVLE EMENT: <br /> • R�rees ko prm�e aq rsquired ex requestatl by the Bsdl�n9�epartrner� <br /> • Ce�"tes Nmt tlte inform � supp(ie(f�b't�8nd GOrfpGt W U'�b�st vf h�}rier krwwiedge. The ic�R recogniz�thsk they <br /> are solety responsil�s fcn' bmittirtg a CUmpiete eppiiCetion being aware that upon fa8ure ta do ,the staff has na aftemaNve <br /> but to rejact it u►rtIi it� . <br /> • S�ne ar all of frie irrFortn n that you are asked to pravlde on dus appCtcatlon is Ctassfiied by !aw as aiHter private or <br /> oorrfidentiei. f'rivate daM infamaidw:v�ch generaNy cannat fae g'rv�ta tt�:p�I�but can �ven to the subjeck of the <br /> data. CatfldenGal dats ' infc�tma�0on which genera�r cannot be given ta either Uze pub�ic w subject of the data. Our <br /> Purpose and itrtended u af tl�is irrformation is to annuaHy upda#e our reco►ds and recotds� govemtnerda!agencies <br /> uired b law. N re to ` the ma tiaQ be issuad. <br /> /�piicarn's SignaWre: Date: _ '��/'�� <br /> �a�st upaa�ed: o9�oa-zoi y <br />