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� � <br /> b°� <br /> �� City of Orono �� <br /> . f'' Building permit Applic$tiQn for int�rnal Work <br /> � (windows, doars siding, re-raof, etc. <br /> ��� AA01�B�(98 PO��'li��Urnbue OZO1D�-G�S� <br /> Q d Cryytal BaY,MN 5q23-0066 D���y�p � <br /> �r ShoerAddress: Roe�iyed�by; ,Q <br /> �o € 27s0 Kellay Pa�y Pf�n r�eria�w t�,v: — <br /> � Orono,MN 5S3S6 <br /> Moln: 06&24� Fe�c: 9S�2ao•4e�e .d.o�ono,mn_us T�p�' ��'�� <br /> Th13 applicat'i0n�fdrm must b�oompleted It1 full and all reqUired'infom�t�on must oe subM ttod. <br /> h�r.o�pletb appllcatlons wfil be�eturned. jPlease prlr,y <br /> GENERAL INFORAAATION:� <br /> Jo6 Slto AddnCss: b� _..�, <br /> Wfll th(s be a Parade omes, Remoa�b�a g►�r,agg Nome or other Display Home? �� Yee o <br /> liyr�a.p�oipl�psdrutl�ioqril�roel x�rr Po�ce O�eparpl�lsrn and Ohy Oo�nolr epp u�q ED aqytl pe�r b Un c�nf. Shullk bus xrolao es <br /> roqidrod uroltlt app�a�nrananaMa sNliciom o�s/fs p�urkJn�Is a�eAeble. No,n•p�am�dlor!auamF w�1M�t hQ allbwo4' <br /> CON7'FIAC'nOR/APPi.IC'AMTINFCRYATIOW: <br /> Name: � <br /> ��'�� 6cpirallon ate: �31.1�„� 1� <br /> Phone: �•- - office r-0I <br /> Mailing Address: ' � ; � <br /> Con�M�e�son: a ' App iccnt iet <br /> Email andlor�ar. / eowner tc�o onn <br /> �,- - <br /> PRDPER7Y OWNER INFORMI�TI Nt � � � O <br /> Namn� <br /> , ' - <br /> �one td�rr. � ,r.� . � <br /> Atldreae, Ci : ZIP: <br /> Emeil 8ndlor Fax 1` <br /> �.. . _.._..._. <br /> PR CT IHPORMATION� � ; , . <br /> 'rY� °0� . MY�e�Movement rt�ay roqube <br /> 111CWQ review��psnnitz <br /> 0 Doer(s) []Aem I �Wate�Damego <br /> ❑WI�low(� �eps�r,� - �torm O�m Mlnno�,at,s ersek Watershed Dlstr�et(MGWC� <br /> � 162G2 Minnetcnka Bhrd <br /> j D98phpYpih,MN 53391 <br /> ❑sido+g ❑Reeh�rellon ❑O�h�r.(Speo1M Pnono� 662-4T1�o5so <br /> � Fe� 952•qTt-066Z <br /> B�Op� [��Ire Gnmags <br /> I Pro)eot osscrtptlon: � ' <br /> .�.... <br /> eatlme�ed Constructlon Valustlon of ect excludi an S � <br /> APPLICANT ACKNO'WL.ED L=IiAENT: � <br /> . 11p�eeB tp provide ail� ormation required or reques�ed by the 8ulldinp DepartmeM; <br /> . Ce�'ies�Aa1 fie i�faRmatlai suppf�d ia t�ue and cvr�eet to the best of hlslhar knowladge, Thu applicent Re4qnl=ee the!thoy <br /> ere solely reeponofbb�or�uDmidf�g a comp►ete application being eware that upon laiiure w do so, �Ao q�M hAs�o altemative <br /> bu�to ro�Oa�un�l le ia campleee: <br /> � Sama ar a0 0/IFw Inle�oen ehal y�u era se(aoq to ptqVlq@ On SA�epp�catlon (S �d Dy StsCe law ne elftk�prwaC�er <br /> co�fidenad. Privab�dAta�ia iMormatlon whloh pa+tiorally cannot be given 10 ths p�boc ba can De glvon to�e �ubJoCt o�the <br /> d�. Corlfidetitie! daSa i� IMo►madon w�dch gonorally conn� oo given tu �iltrer lho public or U1� t�DJ�af the daSa. Our <br /> pufpoa� +1nA IrnAndAd u�i al�hl: :�torm�on �to annuelly updds w�r recc�rqs enf�l I�bOb(d0 vf o{�e��overnmpn�l ep9nok, <br /> I Ao to e 1 i i the on � do I�scuod. <br /> 1 g <br /> app��anc�s sip�rature_ � oe�e: _.�. <br /> ti,ti:a6pd 9ti9b6bZZS6��l 90T9S0bZS6Z �JNIl�d�IlNO� 3�I� M3N�w�-�� S£�8ti 690Z-9z-Jfld <br />