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To� 952-249-4616 From: Spencer Mistelske Pg 4/ 4 08i02/11 12:44 pm
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<br /> , B�:i;ldfr�g �+errti�it App�ication. far In�eirnal 1Nark
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<br /> 1N[Il..thf�be:a:Parad�:vf:��ii�es, Rs�rivd,ele�S ::k�owGa�v. Mome or ottl�r Di�pl�y;Ho:nne? Yes No
<br /> tf y�s;.a�pa���av�rrt�&irrtft.ls r+��ited WiCh:F'�Ilce:Odp�r�n�edt 8n;1�Pty Eoc'ncil epp►ovaf 60 days prior ta the e:v��� �Sh;uttle l�us seruice.�1lI�a.
<br /> req�lred un�Qss�rpplltxvrat i�e�'wnsh�tes 9Wtoi�riFpn-ei��pyiking is evi�ilBtus: nto�t perrn/Eced dvents wflF�t te d/ld�a�l.
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<br /> ��tirna�ted Gan,struction.;1/al.uatlon of?so]eaf.(excJ;udJh Fand • . :� 4;;7
<br /> o4P�'L:�C+AN7 ACYfNQV11'L.EDC3ENtENT� ..._�....�......._.
<br /> •: ,4�itaau to.pmvid�al�lnfam��on r��ur�el or re,qw:�asted by.fh�9'�ilr�ing Depertrherrt,
<br /> � Gerti�I�.s that:ttie:inPormatfor�su�apff�� fe'true..:�nrJ C��re.�C:tO tlie�8�t of�i�/�(EP.Kt�6w�1��g�. T1�B Appllc8i�t t�C�gt11��8 ttl�f UiBY
<br /> �tt:salblY r.e�pqn�it�l;� for subrtilttir�g a�ompl�te.��p�ic�tlon 6eing aware�:th�aR'up�n:9a'ilwre 4.o do sc�, t.he�taf{h�s nc al�arnat1Wv
<br /> b�k.to reject`it'unlil.it is campl�te;
<br /> Soi1�s o��I 3he inforhtatKirt'.that yctu a.ro ask@d to:�ara�i�¢�:an thie a�ipaicraticri:is clsssiferi by S:tate:I�w as:eitFi�ar privat�.or
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<br /> con#idenliaC arivate d.ata Ps.rnk+r.rrraxlor+ whl�t+ 9onera4fy ca:n.not be �Iwen.ta�ne pubi're but c�� be pi'ven to th�:sutilect.tif.th�3
<br /> Oa2a. .C'ortGdentiaf;idata 'r§.Iniafmatloi5 �vhlch gerti�raqy �anr#ot:pv �ivori Fo:�ittier thc.pul5�i� vt tY�� $trby�ct ttrf�k11� c�t9. Out
<br /> #�UFpose �nd int�nd�i t�se of thls Infonratlon Is ta annuall� u�date:o�r records �d r�cards of oiher:governmentaf ag��cles
<br /> re � 'ia . F .ou�efir se. swi ' I the:infori�natran :ttie a licalia�t�s not 6e.Issued.
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