To: Building Permits Page 2 of 2 2017-03-22 18:33:58(GMT) 16512033584 From: Michael Benzinger
<br /> •
<br /> ����` �� ��°�i"��
<br /> BE�iB�d6�� ��rmit A���ic��i�n �'�r[Vi�in��ra�n��d Ftep6ace€�en'�/ R�rnac��� �-���i�l�r�ti�t:�J#��.Y
<br /> �a.�� �a��4�ir��a��, d,r��:r�, �¢��;�,,, �a�-�;�c��, ��c�� ��� °�'f'��3�"��.��'fi�"�.� :�'����a�?�E�.��,
<br /> '�`'� M�fJit) Addl�ss: � �� ��C1�` __7
<br /> �//��� W�� � � E�errtsiz numDAr; ,.�� ��
<br /> t�0 Pi3l..oxoF - . ` - --- �
<br /> , Crystal 5�,y,Ni�d�53�3-fiQfi�u ° 3�ate r�er,eivc�d: � �y � E
<br /> � � h { Stt��t�Sr�c+ress.� � t2eeeived by� ___^___�
<br /> �,\'� .1 m k 1' 275C3 Ks#�y Parkway ! Plara review fee: �r N��
<br /> orcerrt�,M'�4 553�& � , _. ,� �Y�.
<br /> �\��esF�o��'� ; ic,tal Fee:
<br /> ^._ /��� r
<br /> �hAain: �5"�'-2�b�-460a F�x 952-249-�1618 v�,trw c�cr�no r�n��s
<br /> .....,..___» ,..,....._..--- -�.� ,..__. , -- _...._._.L_ —._.� . _.._ ..�.__...__.
<br /> � l'his a�pPica#s`pn#orm rnusf be compieted in f�11��ei ail rec�u6r�d inf�rrnati�,�musi be�ubs�Ti�€e�.
<br /> 6n�orvtpCet�;appli�c.�tions�vit�kas��ttsrn�r�. {Af�asaa pr�nt}
<br /> ��tV�l�,�kL�Pd�`C)t�1Vl�,�'j6�h�: ,.. ( ^� � r:-.. ,..
<br /> �£D�'leiitC7Addr$ss: :"j`, �`..� I # ��1�9't�`)' �r�,",y� �Dra` ` ',;�,lv�,,.�t���,t.7�,�. `-�"�'�"ft f.
<br /> r� � �
<br /> �i1t�P�i���z��'arade of�#�r��s,R�m�del�rs �hovuca�e t��me�sr oth�r�isp�a�f�l�a�^a�°? ❑Yes �Nc�
<br /> ff�S,�sGeciai event;�erma;ts�et�trtr2d wiih Potice Departrient�»ti C;ty Covnr,if apNf�y'd+Gfi day�s prior ta the ev�n2. Sxiuttlo bq:r seru}c��vitl f�c�
<br /> �qurrec�r.rnless�p�ticarrt dam�;nstr,ates si�ffrcisart on-srte;aa.�kinc�rs auai��fXe. NUri-c�er:nlYed evenrs�tiili rrvi k�e atfowed..
<br /> CC3I�TRAG�t�R P APPE.t�C��a�'Id��t7F�9diATit3�1. .
<br /> "', (.�. ,�y � f 1
<br /> el�3ii t 2; �� l�, �t y 1��'� F ,I.`1#"9 4'1 r,p `�-� �� }{�y;t a;�;..'�i t.8 ) �-J f i i..� . -, �
<br /> S4at�;���.��:ens�# �-��t`.. t�'�'��'!u���� Exp�r�i��n���t� ;.� q f ����
<br /> �e�d Gert�fe�:ic�n?�umbe g�,, �-s-_ � �`' ..a.�.�::� "�'' _.,.. �;�pira#Ean C}�te: , ����
<br /> :��..� ;�- _.�?_._�__--�_:_....�._ ---�
<br /> (fcrr�rPc orr homes#t�a#+rr�re eonstre�c#eC�,o!r'rat(X€c�f9�'$ �( �
<br /> �'�itli'l�9: {GeO�} r� � �",j � } V ? -�- r �0�1C:n� L 7, �' �{ � V�� �..�� r 1 �
<br /> .__-J,�__.,_ __.. ___�
<br /> ... ..... _.. �J
<br /> Mailirrc�Addr�ss �-�f ��,.. �� ����� � _`��.. at,,� G�y �,;x � i 3��x.;����!I' _.��`��� :3�1_—
<br /> Cantact P�rsc�n, �; � �,',�?t�:�}< Y� � A�aplic2�rtt is: �ontrac�or: J Ho��t�owne� �c;�e onet
<br /> �r��aii�;�dtor F��x ;�� � -,�-,,_-�_ �.U�.�� ...� �___.,
<br /> �RC3d���41'�'C1�'Vh�EE�i1�iFAi�S4�A"f3t9i�:
<br /> Narr�e:
<br /> ---.. . .. . .- -..._.._.._. _.........__
<br /> �i�one(cl�y):
<br /> ------�----. ... ..._ ..
<br /> Address: C�t�. �I�:
<br /> .._�_..— .._...._,.._�__..,_._._. .,.._.._` _. _.__. __�.__,� ,
<br /> Emai!and/c�r Fax:
<br /> p�(3,���T 4�1�t3f3�Ae��4�P+t: Uvera(I project descri ti��� �: w___. __ ._ _�___._ _.. -
<br /> _...___ .._.._.__ . --�
<br /> € Ty��e o�Pra�eci: � Arsy earYh�e�iverrae�r�f may also re�u3re
<br /> ! ;:..�[?at�r(�) ❑R�snode� [�F'ire Dam�ye �
<br /> h8C�1(C�review 8�perzra���
<br /> ;t�linr,ehaha�:re�?t W�tter�h�d CD��tt'�cE(P+IICW�}
<br /> ;�Re-ro�f,t�s,#eal4 !�e [�Stnrm€]arna.� : '!
<br /> i� U I�ii � •15�2Q tu�inr�e4flnka 81v�
<br /> � I�R�-�c�of,ceefar ❑R�storati�n �Wr�ter[3amagQ ! Niinn�8+ans�a,lw9�i 5���5
<br /> � � � � � � Phore;�9.�`i2�47�-Q59fi
<br /> � ❑Re-a�oof,�the�(s�aac6€Y9 Q Sid�nc� [„]L��her:(s��cifyJ E'ax 3;�471 06A� i
<br /> %.�Wirdowt�) � �vww.mynnEl �h�crpzk.a�
<br /> - - . --- ..� _.__. ___._ ___....._ __ l
<br /> _ _ ..._ ..r. .-
<br /> Estin3�€ec! Canstsue#ian Va9u�tis�n af�rcaject��xc&�ding 9artti� $ � �' � � �--'
<br /> A�'PL1�Ald�ACK��!lVL�dG�I�ti��"�`:
<br /> __.._ . __ .....�..r._. _.._ __ — ---_. ..W._ ..,...,._,_—
<br /> , A,grees ta pravide ai!ir�i�•�rr+atiui,required ar reqss�statk tay i3ti�Building a�artment;
<br /> 3
<br /> • Gertifi�s ttsai ih�intzzrrnati�rr�sa�plied as Crue�nd carr��:t icx tha bsst af t��slhcr koao+Medg�. TFy.��ppl�c2,ni reco�n#zes�h�at t,t��;y arc; �
<br /> �o{ely res�nsebiQ for subm�ttir�c7 a carnp�.sFe applicailacr b�ing a}nraR�t)�a#upor�f�i#are t��o so,�e sta�f has iso aitemative but i�
<br /> ! reje�:t it uniil it is corr�piete,
<br /> � • 5�me or �fl 4f_thE infarmatian lhat �ou �re ask�:d ia prc�vrd�c��a� Ei7is a�:�l�caiir�a� �s clz�sifi�d by State law �s �ikts�� privaEe nr
<br /> E
<br /> confi�e�iial. Pri�lat�data is'sn�nrm�t(c�r���rhich,eneraify canr�ot kaa givsr�k�r rhe��ab{it,k�u#c.an b�;��v�r ta the srabject of fh�da�a.
<br /> i �c�nfici�r#ial data is inf�rrnatar.�rr wlaic�gen�€a({y r.�n.not i��giv�n to eith�r t�� �uf�lc ur the subject qf tha data. �ur�urpose arRd ,
<br /> � intu refuse tt�s�fR;�f i4he infarm � {a�nnt�af6y t��ivai�our reGor'ds�n�!roc�rds of��hE�r c�raverrrmantaf�encias requirad by f�w. lf ;
<br /> � s•
<br /> �-...Y°.---- y �'....�. __ �_c�n,�4ie aP�l�c�t�on r�i�not be issued ..._.� `'
<br /> f __�.. _,.......,�--_-----...._. --
<br /> f�'J....rx� � �,•' ,:y t { .' ^I_
<br /> ,�pplicant's Si�nstur�i, ��I �,. "' ` Uate: '�t���.-� / f 7
<br /> ' :�.
<br /> f� e;. + ��...__ _
<br /> ���_.��
<br /> G�tn��'s Sig�aturt�: '_� �^'`��� ,...� C}ate, �w...y.. ..,.m..�
<br /> Last Upda6ed:January 2076
<br />
|