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Sep-02-2010 07:50am From-CITY OF ORONO +9522494616 T-464 P.002/001 P-628 <br /> � � City of Orono <br /> Building Permit qpp�;cation for Inter�al Wo� <br /> (windows doo k <br /> i f9i SId111 s t�f.'.roof� AtC,� <br /> N1d�rtp Add/9sa: <br /> O�'��' PO Box 66 PemuT numbar, a{b/D—dd � / <br /> O �ryst�l @ay, MN 55323-0066 D a t e r e o e i v e c i; �/ /d <br /> � '� Street Adclrss&� ' Re�ived by: <br /> � �c,� 2750 ICelley par�y , <br /> Orono,MN 55336 P�n�Wewfe <br /> Meln: 652-249-4600 Fax: 952-2eF9�616 w�.a.orone mn��_ TGtal Fea; �'�3� 0�0 . <br /> rn��aPP��a��must be complered in full,and all raquired'mfonr�tio�must ba submitted_ <br /> incomplsts applicatlons will be returned. (P/easa�pr�n� <br /> GF.I�IERAL INFORMATION: <br /> Job Site Address: ��5'�/�,��-�4��� � . <br /> Will thls be a Parade of Homes, Remodelers Showcase Nome or other Dlspfay Ho�� Yes <br /> dYes,e sDea��l er+enl Pam�b requuisd witA Porioe Repa�unent and CXy CounrJl apPiovel BO de No <br /> ^�Vu�d uMeae aPP��demo�►s�retea srrfl9den�on•sice Pendng is arahable. N ��a�o Ehe evanf. Shuula D�s ssrvroe wNi pe <br /> CONTRACTOR/APPI,ICANT INFORIWqTION: �e����wiu not be a�d <br /> Nall'IB: �C.��R.V'+.tr �'r''4 S <br /> St�f9�1cCORS2# �p <br /> Phone: � ExP�ra�Date: 3 <br /> MalPnp Addresa: �a`�''� 7- o o � <br /> Corrtact Pe►son: � , �' . _ k� S ZIP:5'� c�� <br /> E.rnall and�or Fa� " v�c " _ �►Ppllcant is: / Nomeowner <br /> ' /6 �'a rG�u.o�., <br /> PRop�►owN�iNr���oN; <br /> Name: K�vt 4 ev e,,r I C�r�„��� <br /> Phcne(daY�� 95 - W 7�� �, - <br /> Addr2s& �(� 'ff'S �o�+c, (.�,(�+. l ts Q �� <br /> Ema�1 and/or Fax -�' �..CiN: L,o zg____�p;�g.3Sb <br /> , <br /> PRC�J�C71NFpRMAT�pN: ' <br /> Trpa of Pro�ect: <br /> My aarth movo�ment may requlre <br /> �Door(6) 7a�-:o ❑Remodel ❑Waier Damsge �CWD►eviaw 1�pent�it9 <br /> �1 Windaw(s) ❑Repair M'mr�ehaha Croek WaPanehed�Istrict(MCWD) <br /> ❑Sto►m D�nage 1H2O2 Min�wtonka @Ivd <br /> �S�� �R�a�d� ❑Other.(speolfy) �Phaven,MN 55391 <br /> Pnone: 9E�a�71-0gso <br /> ❑�0pf ❑Fre psmage Fax: 952•a71-0662 <br /> Overall Pro t 088Cfi ' • � "—' �M!minneh�hec�{�p� <br /> � h �,� Wti�ec� a � q e oe r � <br /> Estimated Cans�ucdon Valuatlon of Pro)ec (escluding lan s -',"��-��=^` ����S <br /> - •- oG3 .o�.� <br /> APpLICANT ACKNQUyLEpGEMENT; .; � <br /> • A9�ee6 to pravide 911 iMaRnation r�squlred or requested yb the gulldinp DepaRment; - <br /> • Certl�ies that tt�e Informs�ion guDP����s irue and correct lo �he bast of h�s/her Know�e <br /> ar6 aolely�asponsl6le for submiping e cornplete appiication being aware that upon faii�to d�o s�o�,Dvi��ff�g���Itemaeve <br /> but to reJgct it unGl R 18 aomp►ete; <br /> . �. <br /> • Some er all of the infortnatlon that yau are asked to provide on this applic.a�On is dassified by State law as either pnvate or <br /> eor�fidendal. Private de� i� Informeuon whlen generally cannot be gfvan to the pueRc put can be f�iven to the subjaa of t� <br /> data. Confidentla) datq is iflfarmadon which pene�ally cannot be givon to either tl�e publfC o�the su6ject of the ddta. our <br /> purpose and irrtended use of this irt(ormataen ia to annuaUy uDdate o�r r000rds and re�8 p/othcsr governmental epenoies <br /> �a uired b r�w, If ou reluse tn 3uPp�the•mfoRnetlon th_� Q 9GDPrption ma r�not be 1�euec! <br /> Applicant's Slgnature: r <br /> ��- ��-� Dat�: �- L- /C� <br /> -� <br /> �c uadatea: oe.e�-sons <br />