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AUG-*7-2Q11 15:39 From:�ORDON JAMES � <br /> t �,w`Z�_ � <br /> '� � � <br /> �- a <br /> �ity �f �ron� <br /> �u6od�ng Permit Applicati�a� for BnternaB VV rk <br /> (windows, �doors, siding, re-roof, etc.) <br /> .$�:• =:.,. �Yiilirry Acldress• PeRr1ft num �: o.?d//' �l�9D <br /> f�.[i,,��:`�,, PC,7 FtoY 6fi ��� <br /> �'O�r Q�t cry�eal eay,�++N:��z:�-one,� r.��ce�ec�� <br /> '` �� RPceiveQ by. <br /> �� '�y- �,, 5treet Addiess: ' <br /> ��,��, �� ��'i 275��te�lle�PrarlcwaY Plan r�vi�w f o. _� <br /> �'*� � Oranu:AAN 55356 <br /> ,:., �¢;.. <br /> ..3-. .-:" rue�i F�. �yp7. �39 <br /> Mr�in� 952-2d9-4S00 Fax: �52��-++�161Ei www,oi.cxono.mn.us <br /> This apph�.�tion form must bs completed In full and all reGuired informaUon m��st submilted. 33-t18-Z3-iz.-ODS'] <br /> Incomplctc�pplieatfons will be retumed. (F'lease printJ <br /> GENER�►L INFORMATION: �/ 2I GS <br /> Job Site Address: �"1 Icrp„ �pgr �r ��0� , '��V J � <br /> Will thi� be a Parade ol'Hamea, Ramodelevs S vwcasc Nom r othar Oisalay H e� es Na <br /> 1t yes a speclel evcrN p�rm/t is rpquine0 with Poll��r lJdpsimne�n�sncl c;�ry[:nimr.if t+ppr�v�!60 dWs prior ta fnc c rN Shutflc bus soniica wiU� <br /> requir5d unlo.••��ppiJ�unt d�naruslrotcs sulfmiaM nn-sile nerking�8v8ilet+ln. Nompefm/tted olronRs not DE adOwlad. <br /> GONTRACTOR f APp I.ICANT INFORMATION= � <br /> �v��T,�: G-�c�dor.Ta v�c��S� �-or` _��`_�t'0� <br /> St�te Lic�i�e# �a��t��_ Expiration D�t � ?a� � �J� _ <br /> l.e2d C¢rtifir.atvon Number. �t �— ExpiraL'►on Del __r <br /> (for werk o�homes tl�at were conss►uc[ed prlor ro 1976 <br /> ('h�np (�3 • ---- -- _��rr�) _ �12 , g8.'q.--3z.. � �ceu� <br /> Mading'�Address: . � � -- Cily �,� 1��,� zIP: _ -� <br /> Gontecl f�eryo��: ��� � Applica�it is: u tra� Homeov�ntc� lcnud ono� <br /> Email and(or F�x: w��� C�p _ __ <br /> cJ <br /> PFtOPEl27Y OWNER INFORMATIOPI: <br /> tvam�' C��.�'� ��,�.5. �.���P�P�n.�"' ��(b.��--- -•--- <br /> PhonP(dayj• -'l, ^ S'��y <br /> Add�ess: W . • '�"'' "'j. C:iiy. 21F': � �-((,b <br /> �l2���— ----� —•--� <br /> Email a�nd/or Fax ►�/�1�..�vrn �c114.dY�i'W P� __._.. .-. .�.(..`��Q f��m�f . ��b`� G j,_ �l�o+�v. <br /> PROJ�CY INFORM/1TItZN_ <br /> Type of�roject: �� �� � � My oart� ovement may requlre <br /> I.� U�nr(�} I ;]�model ❑Watc� D�m�gr � MCWD svi�w 8 pormlts: <br /> AAinnehc�ha Cree Walershed District(MCWU) <br /> ❑VUindow(s) ; L Rop�ir f„�Storm Uama,yc I 182U'l MmruslUnkv Blwd <br /> ❑Siding I �Restoration Other.(r�xacl ) � UeQp ��cn; MN 55391 <br /> � Phon � �JG2-47�-0590 <br /> p Ft�-roa� ' C] �ire D�maga � F�x� 952-d71-f1('�2. <br /> � � www.m haharxr.ak. <br /> L. <br /> Overall Project Description: _ _ ______ <br /> Ebtimated Construetlon V�luati n af Projsct(oxcluding land) __ � !� d <br /> -- ��--�--� -- . ,..._a ......_. <br /> APPtICANTACKNOWLE�GEMENT: _. _ ___ . _. <br /> Agrces io prcvldo��II irzfoRnt�tion requi�ed or requegted by the 8uilding Ueaartrnent: <br /> � Cerlifies thal the ii�formuUun bu0p��0d �S l�ue and u0rr�+c:l w pi� �C�l uf!iro(1»i kiwwlddye. 'r ie applKant n:wgniz�s that they � <br /> �re so�ely responsible for submitting a camplotc a�if on being aw�rc t1�nt upu�� �ailurr to o so;the staff ha� no�Ilemativ� i <br /> bu�tn r�JpGt It unlll�R IA r.Am�IRth• . � <br /> � � Some or al! of the Informatlon that yei�afe r�Mk fn provldp nn Ihlc apnll.r.aGon iF�.las�itte�d by Stgle iaw az either private or <br /> confidential. Prlvala,�sata ' ' rmayafi whl annr�lly carnat ba�iven Ic1 lhA puhlic but • n hn plv�n ta the subjecl af the <br /> d�tti. Ct�nfidenli data is info I�cn whic ge�ersll cannot be glver• to either the puhlic or the aubjecl c�f Ihe de'l�. Ou� <br /> purposr� and int��+ded use of " i form ' � Is to a ually update our rccords �nd racord� of other perv�r�imenlel t�genaes <br /> �__ ._ ru ui��ed uy law. II�You raFu,e .o sup .ly e ir►formau � the�plicstian ma noy t be issued.__ _ —._.J <br /> Applicanl's Signature _ Jate- � ` <br /> :�31 UPdaldd, �Y3-01-2011 <br />