Laserfiche WebLink
From:ELDER JONES INC 952 854 ,4909 08I23/2010 06:31 #138 P.002I003 <br /> City of Orono ' <br /> Buitding Permit Application fivr internal Work <br /> W111dows, dool's, siding, re-roof, etc.) <br /> Mel01+9 Aoafress: Permit number: �l� ' <br /> �� �,O PO Box 66 Q <br /> Crystal 6Sy. MN 553Z3-OOgO Date rectivod: . v �h' �� <br /> Svaotaedness: Received by: <br /> � � Z750 Keiley F'al'kWay Plan feVlew fee: <br /> Orono,MN 66368 � <br /> Total Fee: AI � <br /> Maln: 952-249-4800 Fax: s52-z49-4�10 .G. .0 f <br /> s applicabion fbrm must be comDleted in full end ail requlred infortnotlon must be submitted. <br /> . • InComplete applice�lona witl be rcturned. (Pl�ase print) <br /> GENERAL INFOFiMATION- �, / <br /> Job Slte Address: S�'S L D'n ��' 'G�► ' �/ �� , <br /> Wiil this be� Parade of Homes, Remodelers S owcase Home or other Displsy Home? Yes No <br /> /l ye=,o���unl�aPP1��Ce�monstletes�ia�rrc on.slts�rh�ng�e/vod�Fo. Nw+-po��wnts►�vUl n�b�As��ce wl11 be <br /> CONTRACTOR/APPLICANT 1NFORMATION: <br /> Name: _ 'I'Hb At�Hoxne Services, Inc. `!°d. �.fl p�r�l'f�� <br /> state ucense# � 2690 G�unberland Pkwy, Ste 300 4�� ��s �G�celll <br /> Phbne: ��berland pf£�c Park "' IP: <br /> Mailing Address: <br /> Contsct Por�cn: Atlanta, GA 30339-3913 icmeovmer �c��a.ona� <br /> Email and/or Fax: Lic#20268257 Ph. 763/542-8826 <br /> PROPERTY OW1��R PORMATIO�� n d �, <br /> Name: <br /> Phona(daY): z 4 - �o Gi : ��'D!1 O ZIP: �'�� S� <br /> Addr�ss: /S? � <br /> Email and/cr Fax <br /> PROJ T INFORMATION: <br /> Typc af ProJoet: My earSFl mvvemsnt mar!'+aqulre <br /> MCWD rovlow 8 permlte <br /> ❑DOof(6) ❑Remodc) ❑Waber Damage <br /> Mlnnehaha Creek Watershed DistrlCt(MCWD) <br /> (�WirldOw(s) �ftepeir ❑3torm Damago 18205 M�nnwtonks Bivd <br /> �� oeepnaven,MN 55391 <br /> �]Siding ❑Rertorstion ❑OVI�P:(specii�r) Phono: 852-�471-0690 <br /> Fsx: 952�71.0682 <br /> ❑Rs-roof ❑Flrv Damage • � �k•a <br /> Ovefall Prvlect DascHptfon� �W��1 0{,+ n�f� Q !J�/�7 ! 7�/ 1 � � O ��,n � <br /> �stimetecl Construatlon Valuation of Projact(cx�luding land) � $ 8 v <br /> APP�ICANT AGKNOWL G�MENT: <br /> • Agrees t0 proviCe all irtlbrmation rcquired or rcquc�tod by the Building Dopariment; <br /> ■ Ccrtific3 th9t the informil4fon supplied Is tru++snd ooReCt tA the bP.St o1 t118/h6�knOWIAtl9e. Ttte eppliCe►lt reoogn¢e9 th9t they <br /> are sol6ly responsible fOr suDmlmng 8 Complete appllcation being awere th�t upon iallure to do ao, tho stsff hsa no altomative <br /> Dut to reJ9ct it until it i9 oomplat�; <br /> . 3ome or oll of the i�fonnatlon that you are ��ked to provlde on this eppllcaUon Is c18561flA0 by 3tste law as either pnvete or <br /> confidaential. Prlvabe dste IB Irnormatfon whlch generally cannot be given to the publio but csn b� given to the subjeet of thQ <br /> Cata. Coritidentlal data is Inlormetion whlch generally oannot be given eo ekher the publfc or the sublect m n1e dete. �U� <br /> purpoe•and intended use of tni� ir,tormatlo� ts to annually uodate our records and reoords oF other govemmenta! agencle� <br /> re uired b law. 1t se I the Intormation,the a lic�on ma no b•isausd. <br /> ApplicanYs Signature: X /� �a�= g l� '3 l� � <br /> / <br /> ��t uvde�ea: os.oa-soo9 <br />