Laserfiche WebLink
City of Orono <br /> Buildin Permit Ap lication <br /> O���O ��PO 8aa 66� Parmik numbsr. <br /> Cryeoal 9ay, MN 09323-0066 Osts roeeivsa; <br /> " Stnart Addrosa: ReosNed by: <br /> � � 2T50 Kdley ParltwaY Plan revlew�ee: <br /> '�a� Orono,MN 55358 <br /> _ = Totel Fee: <br /> Maln: 932-248�4800 Pax: 852•249�4818 www.d.orona.mn.us <br /> hie applfcation form must be compleled In full and all reQulred irnormation must e suDmtttea. <br /> Incomplebe appllcatlon�wlll Ae returned. (PI9As9 pl�nq <br /> GENERAL INFORMATION: <br /> Job Slte Address: 3S S' 3 j L;�; s kw f��•t OITw+ >►-,,�•S 5 3Gy <br /> Will this be a Parade of Homes, Remodelers Showpse Home or other Display Mome? � Yes No <br /> Hyss.a apselN s►bM oennl!la�epdrsd wYlh Adios Cspsrhnenf end Cib�Coundl�paroNeJ 60 Qeys prlor te the erv�nt Shufds bun bwvtm wip he <br /> /�GUN'ed unlass AGDIf�It doYnansbaaas atAlici�t on-el(91�8/IdnC It eValleDle, Non•OSRnlflltl 6VAnts►WA not be aYowed. <br /> CONTRACTOR/AP UCMIT INFURNATION: <br /> Neme: 1CIC �S!3C/i /JE QuK,�`�f s'u.1-'F�a,L' <br /> 8tale Llcense# �C l iI.7/�.E� EXplratlon Date: 3- �•-/� <br /> phone: I t� 'o c` ofAce) � (cell) <br /> Malling Address: i t t�S Y�'. ,�,�,+ r-._. City: /!�v+ti.s�� 21P: S'���r L <br /> Contact Person: :-n �� Applieent Is: Contra or ! Homeowne� �cra.on.� <br /> �mail and/or Fax: �,�,,d� �t►LR1 c«s ,N�r� <br /> PROPERTY OWNER INFOIZMATION: <br /> Nema: S' . � a...l •. �R s <br /> Phone(da�: i— I - G Z <br /> Address; 3 f �. ��' v�= Clt : � d ZIP: S.3'4.S/ <br /> Email andlor�ax <br /> PROJECT INFORMATION: <br /> � � Aror anh mw�m�t msy nquln <br /> MCWD rwi�w i p�m�ib <br /> Q Door(s) �Remodel ❑Waea►�amsge <br /> � MinneNaha Greek Wacerehed Distric[(MCWO) <br /> D Window(s) Q Repair . , • �Stenr+Demape 4A202 Mim.bonlo.61vd <br /> Daephave�,MN 55381 <br /> �3iding �Restoration �Othar.(apecity) Phone: 9�2-4T1-0580 <br /> Fex: 952�71-0882 <br /> R�root 0�Ire Damage w�w�w.minnshahpereak.ora <br /> Orcra�l ProJoet�asorlptlon: <br /> Estlmated Constructlon Valuatlon of ProJect(oxeluding land) i 3��•b°' <br /> APPLICANT ACKNO DOEMENT: <br /> + A9rees b pre�ride all in(omwNon requirod or roquoatod by tho Buildina Departrnent <br /> • Cenifles Utet fhe irifOmiatlOfl supplieC Is true s�oOfisCt lo tl1e DeSt of hlslll�k1aNAadga. The�pplieant rar�gnizas tl�a!Ihay <br /> aro aolsly rosponsible for auhmitiing a oomplets Applioddal being awere that upo�failur.to do 90,tha sis1T haa no altsrhA�iVs <br /> but eo r'ejeot it until i!is oo►nplate; <br /> • Some or all of the Mametlon tl�af you ara ask�d In previds on lhis 6�ppflcad4f'I i�d6leslfied by SEate law ae afher privabe or <br /> corrfide�mial. Prlva[e dafa is iMorrnstlon which pansfaily cannot ba 91ven lo Ihe Dubllc but can be giwn to me sue�eet of the <br /> daM, CoMidential daW is iMonnetlon whiolt generolly aannot bo giv.n to sifher the publia or Ihs subjeet e1!he dafa. Ou� <br /> puqwsa end intended use ef fhis IM�nnnetlen ia 6o annually updrti.our r+.00rd+c and reoonla aT olher qovemmeMal agencles <br /> required by law. It you refuse to supply tAe iMorrnation,ths applir,Ation may not bs issuod. <br /> AppQc�nt's 3igna[ure: _ _"_ _ Z� � � -�� " ^ Da�te: 3��Z 5 '—�`l <br /> �Fa�l <br /> 6/l d 919b6bZZS6+ « �bS06SSE9L 3N2108S0 �121t�W 1E�80 6l-Zl-OOOZ <br />