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S��/22/2�1�/WED 08: 06 ANI P. 002 <br /> _ � �n <br /> " CN�y o�F Orono � �� <br /> Build�ng Permit Ap�lic�tion for Infiernal lll/o��l� <br /> � � (windows, doors, siding, re-roof, etc.) � <br /> • Mal1ingAddress: P�rmit number. ���' QdB�f� <br /> 0.�,0,�.� PO Bax BB .' <br /> Crystal Bey,MN b6323-0066 ��t�a received: �/D <br /> L Received by: <br /> a� " �. Street Address: <br /> �., 2750 I<elley Parkway Plan review fee: <br /> �����o�,k� Orono, MN 55356 <br /> Total Fee: ��3� g� <br /> Maln; 952-Z49-4600 Fax: 952-249-4816 www.ci.orono.mn.us <br /> This applicatlon ft�rm must be completed in full and all requirad Information must be submittod. <br /> , InGomplete applications will ba rekurned. (Pleasa prinfJ <br /> GENERAL IN�ORMATiON• / L�n � ; � <br /> Job Slte Address: �o� q� Lo 1�Q �t 1/�L � �,4-e. <br /> Will this be a Parade of Flames, Remodelers Showcase Home or other Dlsplay Home? ❑ Yes �o . � <br /> "-'—'-1f'yes;-�''��fEiCl�l'A'V@'I1FpErIfi1F75`f�JUYI9t7-WIfA'PnOCe=Dep6hr+78n(-and-Elry=CouncJ!-apprcaval-@0=deys-prlor-to=�he=evenG-�hattlo=bu�_oor-viao_w1/L•b�_�_- _.__-:._ <br /> ioquUed un/sss epplios�nt domonsPrates sufficient on-�tita p�/king Is avallable. Non-permi[fed events w!Il nof bB ell0wed. <br /> CONTRAC70R/APPL.ICANT IN�ORMATIDN: � <br /> Name: THD At-I�o���e Services, Inc. . <br /> State License# 2690 Cumbezland Pkwy, Ste 300 <br /> Phone: (cell) <br /> Mailing Address: Ctunberla.nd Office Pa�•k zIP: <br /> Contact Person: A.tlanta, GA 30339-3913 lomeowner (Circle One) <br /> Emall and/or�ax; Lic�fi20268257 Pl�. 763/ 542-8826 1.0 d� �O L/d�r 1 D n�3 <br /> PROPER7Y OWNER INF MATION• � q s�13�13•�o �l7 <br /> Name: 6/) a ��J`�d � <br /> Phone (day): �l S� 35 • �'n Y v � <br /> Address: . O / C�l L Cit : ��n� zip: 'ss 3 G S' <br /> Email and/or Fax <br /> PROJEC711�FORMATION: <br /> Type of ProJect: Any earth movement may require <br /> MCWb review 8�permlts <br /> ❑�oor(s) ❑ Remvdel ❑Watcr D9mage <br /> Mlnnehaha Cresk Watershed Dlst�l�(MCWD) <br /> jndow(s) �Repa�r ❑Storm Damape 18202 Mlnnetonka Blvd <br /> � peephavan, MN 55391 <br /> ❑Slding ❑ Restoration [7 Other:(specify) Phone: 952-471-0590 <br /> Fax: 952-47,-oes2 <br /> ❑R8-(001 ❑ FIf6 QaftlaAe wvwv.minnchohacr�ok.oCc1 � <br /> Overall Project Description: W/ o C(U rnAl1 l � /, i � � n i � <br /> �stimated Construction Valuation of Project (excluding land) � �D� �' J 7 � � _ � � . <br /> APPLICANT ACKNOWL�DGEM�NT: � � � <br /> • Agrees to provide all�fnformation requlred or requested by the Building Department; � , �. <br /> — . a ��c� a c rma�on•supp� — --�- <br /> are solaly rR�pon�ible for submllting a complete aD011ca�lon being aware that upofl fallUre to d4 so,,the staff.has no elternaifve <br /> but.to reject it untll It IS Complete: � . � � . <br /> • Some or all of the information that you are asked to provide on this appllcatlon is classified by State law as elther private or , <br /> I confidcnti�l, Prlvato dsts is informaQion which gQnerally cannot be givQn to the publ;a but ean be.glven to the subject of�the <br /> d2t2. Confidantial data Is Information wh�ch �enerally cannot be �iven to elther the public or the subject of the data. Our <br /> pur�ose and Intended use of'tlifs Information is to annually update our records and records of other governmental agencles <br /> re uired b law. If ou refuse to suppl the intormatlon,the application ma not be Issued. . <br /> AppficanYs Signature: <br /> Date: l �� ! �r U <br /> Lest Updated: OS-04-2008 <br />