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FROM : Donnelly Brothers PHONE N0. : 8668662 Aug. 13 2010 05:44AM P2 <br /> � , <br /> ; ' City of Orona� <br /> Building Permit Appl�c�ti�on f�r� �nternal Work <br /> windows, doors; siding, re-�oof, etc.) <br /> Mailing Addrsss; Permit number, <br /> g O�O po e�ss --�- <br /> � Gryst21 Bay, MN 55323-0066 Date reoeiv�d: <br /> a Strset Address: Received by: <br /> � ������� Orono, MN 55356 Y Plan reviewfe�: <br /> '�a <br /> Total Fee: <br /> Main: 952-249-4600 Fex: 952-249�4616 www.a.orono.mn.us <br /> This application fortn must be oompleted in fuq and all required informstion must be submitted. <br /> Incomplete applications will be r�eturned_ (Please,print) <br /> GENERAL INFORMATION• �p� <br /> Job Site Address: ti��5 O�n �J'�Cu� �.t� ; <br /> Will this be a Parade of Homes, Remo lers Showcase Home or other Dlsplay Home? ❑Yes No <br /> li yes,a speaa/event pemiit is r+equired with Podce Depaib»ent;and Ci�Cound/approya/60 days priaw M!he eve,�t 5huttle bus seiv/ce wr!!be <br /> repuired unless apWl'rcant demonsbaEss s�A�CieM o,�site perking i�avar7able. Non-pen»ifted e�►v�71 not be al/ow�ed, <br /> CONTRACTOR/APPI.ICANT INFORMATION: : ' <br /> Name: 1��i+k, StU.C.CG [���U�n��lti ��fU��S <br /> State License# '�p(a3$?,�q � � Expiration Date: 03 l 3 I ZJ lL � <br /> Phone, ��L-_dls fn- �'Lv4 (o�ce) 1g�2'15\-1.SsZ� (cell) <br /> Mailing Address: L \ C' :1� Z�p; '� <br /> Contact Person_ �M �oJk►,� Appiicant is: Contractor / Homeowner �c�r�►e or�e) <br /> Email and/or Fax: �h,�e\\h1r�+ro�ChvrSs��,tc a@. r�5�, cor.. �l��ti•� B1oco,- <br /> PROPERTY OWNER iNFORNWTION: <br /> Name: ��„�b �t�lu,� <br /> Phane(dsy): �,�ti.'Lc)S-5%t�cte <br /> Address: '2.2.�5 1..u�c�v�a,,� C�,,� City: (�ti�u ZIP: �iS� <br /> Email and/or Fax <br /> PROJECT INFORMATION: <br /> �YPe of ProJect: Any earth moreme�rt may require <br /> YCWD review i�permil5 <br /> ❑Qoor(s) [J Remodel ❑,Wate�Damage � <br /> � Minnehaha Creek Watershed Distrid(MCwD) <br /> ❑Window(s) ❑Repair D Storm D;amage ' , 18202 Minneto�ka Bhrd <br /> ' '' Deephaven,MN 55391 <br /> �(siain� -St t,�C�o ❑Restorahon ❑Othe�(specit�y) , Phone: 952-�71-0590 <br /> Fauc 952-471-0682 <br /> ❑Reroof ❑Fire Damage �rw4v.minnehahacreek.ora <br /> O�erall Pro]ect Descriphlon: St�..�c,o h�us� � ��+►.� a�'kr 2�as�t�a� �►ai�.�,�� r�e ry•��Y� bu c�i�urS <br /> Esdmated Consiwcfivn Valuat�on of Pro�e�t(�xcluding land) � �q �j p� <br /> , <br /> APPLICANT ACKNOWLEOGEMENT: <br /> • Ag�ees to provide sll infiormation required or requ�sted by the Building Depardnen� <br /> • Certifres�tat the iMormation suppiied is true 2nd correct to the best of hislher Imowledge, The applicarrt reoognizes t�tat they <br /> are salely responsible for submi�ing a complete applic�ion being awaro that upon failure Lo do so,tfie st�fr has no sltemative <br /> but to rejec;t it until it is complete: , <br /> • Some�all of the irrfprmation tt18t you are asked to provide�this applic�Goai is dassified by State Idw as either private Or <br /> oonfidsntial. Private data is informa�tion which generaUy cannot be given,to the pubfic but can be given ta the subjed of the <br /> data. Confidential data is informati� which generelly cannot be given t� sither the puWic or the subjsct of the data. Our <br /> purpose and intended use of this informaation is to annvally update our records and reoerds of other govemmsntal �encies <br /> r uired b law. If u refuse to su the information the a licatiom m �ot be issued. <br /> i <br /> A licant`s Si nature: �� - ld�� � d <br /> pp 9 Date: l � <br /> ,' <br /> Lasl Uodaled: 0.rs04-2009 <br />