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Sep 21,2017 12:26 PM To: 19522494616 Page 2l7 From:Go Permits LLC Fax:8604718765 <br /> . � <br /> �1'�/ �� ���C1Q <br /> ... Y ,. <br /> 8ui��f[ng Pertnit Applecation for Mainbenanc,,e!Fteplacement f Ree�not�el— ,.,�"��e'�"��.Y <br /> {i.�.wina�Ccaata�,:.d�o�,sidir��y r�a-rotsf>�t�..".IN€��"Cf��l�C3'Uf2�t1�L�X�;AP3 £?NJ� <br /> _ _ _ _ ._._ <br /> f�� h4arTi pA�: i <br /> �+(�e y Pertnit nutnber: 0 ... <br /> � ��� 1`� CNsta�6�Y,M�5E323-0066 €k�`tCo�ivod: .._ '._.___�I.. __a <br /> (�/1 <br /> �I/ Straet A�ddre�ss: Rec�eived by: <br /> ee <br /> �.� ;� I�/ 275fl Keite�i ParkwaY PI2ei ts�nBlk fse:. _�..�,____.._.._....._.__..__..., <br /> �-'�{�, G� �` 0�0.t�l 55356 <br /> '�Esaco�`� ` <br /> "t ota6�ee; � � �'�� <br /> M3in_ 952-243-4fi40 ��x: 952•249�461fi �Y4��`!Y�'n,fY�bl�f),FYitl� <br /> _.... ._...__. ._..... ...._..._....._............_.._.__.__._�..._..__.�.�._..__._' ...._..'� �_ - � ._�..,� � <br /> _-ThiS 2ppl6r�ltoon form�sust be ocmep3eted i�a fu1E arsd a�requrred infoimaf�on�nust be s�txnittscf. <br /> Fncamplefe appE��tions vir�l be retumed. (�'lease pri�tj <br /> C�HERAL INFORMATION#:, <br /> Jpb Si.�e At3tt�ss: y ( � <br /> ��,,�.�1� t�...�..�.:...._..__._...._____.._.____.__.�_..�..__—. --- _... . <br /> IM1lil1 this be a P�adc of Momes,�'temodelers 3howcase€iame ar other aisplay Hume? �Yes �Na _.__. <br /> icyos�ra spocl�r eveeu Forr�rox w r�nr�i�sar wurt Pakae Aep�+rrr�rnr er,d�+rr Cou�ar aAp�us!GO dars iuia�r ro ene e�, Snuaae bc,s sa�vk:a war ae <br /> reqwere�eantess�nt�ferr+ae+sbates�s7'KMenr ar�•aite parJru�g is evail�bJe. Mon-pe�ni¢aad ewerNs w�1'na b�e�Yc�►w�ed, <br /> co�wacr�r�,a►�Pucanrr i�F�owwanaN: <br /> Name; ��t�..,�'�,.��,,._.. .. <br /> --------------......w..._..__.._._.._.�.�...M_._—_._._.....__�_�.__..____..__._--._........,�.........,_ <br /> Siate I.iCense# ` EwPira�ian��: , <br /> ,.�����'.,�,��.:.�'�_-.� .— �. ,.<-�.2'1�.��.�.�d.��:.._ <br /> Lgad�eM�3�9►►Numtrer �,( '' � Expiratio€t f?aYe:,r}F,{ <br /> _..,,l�.T;�,#�Se�tv..:�._..... <br /> .. ..�.�._. �d..�af.�.�r.�.�'.��_ <br /> (#W wor�r on nomes r�t ware c�onstru�ctsa prior ro��MTe — <br /> �a�e: l���.�.�:��:�5.'_..�1�._ d�) <br /> _,. .__ — — — .. <br /> -- <br /> r�����.�a�s�: .�2�..�',�:�1 _c'ty',�' �,.��zE� ������ <br /> �, _ ,. .� <br /> Cor�ct Persan: ���• . f+PPlicant is: Cor�tfac� 1 l�iomernmer {c�rcde omey <br /> . ;.;.� <br /> F.�naa andfor�a�c � <br /> ; '-� � ; ���'�.�`.�.�.�._.......__...._.._...._..._.._.._�___.._�....._..._..�...._......�_._....�__._.�_...._ <br /> PRQPERTY�ll4tNER lNF�RNtATk�N: <br /> Na�: '�ru� �'v�-�� .__.._..�..._..�.____M....___�_�..�_...,.u......�...��w.�..w....�_.....�....�....�....._. <br /> f�hor�e{day): _�.� ���.�._�.�!.�� � <br /> � <br /> A " ��} ZiP: . <br /> A,f9�dr05;5. _']��?3..��.i�.'�.�.f'Q.`�..�.�>_.__,._--�_,�!�Y'. f)�52.�}.� .__...: . __..:�� <br /> �?ad andtar�ax; _ <br /> .�..�,..�.... ��.�.,..-,.,�.,�,�� .,,....�,.�,rr.,,�,...._.,�w... „�..,,.., .,�:,. �,,.m,.��,.,.,�.,.Nn.,,..� <br /> ��'k(���' f.Lit(t Yl'.�1fA.[#' � �Ff'nf36�!-�f f,.�,�F `a1Z�t'� �� <br /> PROJ�CT iNFaRMAT90N. C3v�erail�rc�eat des�n�fian; ��.�}�t,aC��� <br /> Type af Project _._..____.__......_._....._..... pr�y earxh mnvement may$�so require r. <br /> i4 y �p� <br /> Q[�ao�(5} �f2e�noB�st ❑F'me C�amage #QGW'�rcvievr 8�f�er*t�iis: ��1�"""t�'�� <br /> PAinr*efiaha Gt'ee,k 1fV�Ce+shed Di5trick fMGWQ) <br /> �irc�nnoaf,aspfs�dt [I REspair ❑Sf�rrn Q�nage �532p tiqirmetqr�ca 8tW <br /> C7 R�roat.cedar (,7 R�staraateoa� ('J Watdr Ranrag� Mrmn�#arz�a,R�t a53a5 <br /> �tt,one: 952wai'E-0590 <br /> Q ae-r��.oer,����a I�1 s;e��g [.�Otnar:(�Reci4Y) �a�: asz�a7�-osaz <br /> UYNdqw(sJ v4ww manr�*h3h;��r�S,�,s,:Sx� <br /> ....�,.....V..,,«.....nto.....w <br /> .......,....,-.e.�..._....�..«.....�........-.......—t..r.. ..«.-i...- ......_.. _.._._...._ .._._..___'___.__' __"�__' ..�.__'"'__'. ..............._ <br /> �stixnal�ed�ct�an a�uai�On o�Project tex�cludirrg�andJ S ' <br /> A,PP�ICAh1T AGKP3QWl,�dG�M�NT: <br /> — _ ___._-----...__.._.....__.._._._..__._.._.......___.._....._..._......_......_...__._._...---._.____�._..._�__.___.._.._.........._..__._................................._.._......_. ......._........_... <br /> r � J4g�ees to pro�de aN irr€armatian requ�eal a;►e4+�ae by the Bs�lding Dspartrn6�+� <br /> . C.eatifa`es tlrat[he i�m�ation supp6�sd is tnse and car�cc u�the best of IzisAhcr knrnvfsdgo_ �'!io app&icarn rerngn�zas�ac ghey ara <br /> so6ely responsible frn submittivag a oomP�apP���awaro that upon faiiura ia•�a so,frie s�11as no adt+�matnre but do <br /> roj�et it��1 it is eompBet�; <br /> � Same or a�ot the int�on Ehat you ar�askea ks pru�+iQe�n�is aqplica�tlan is classiFied by St�te Faar as eilt+er privaGe ar <br /> a�nfide�ial. Rrnrabe clata is ir�Focm��which generally cannot be given ta the puW�but�an be geNen to the subjeet of ttte data. <br /> Cesnfi�erqsat d�Ra is i�nation rvhic�c�er+er�ily a�not tsa givea+to eetner ihe A�ic cx#he sub,fe�t af the data. Our�v�pas��nd <br /> inier+ded.use af Hris irr[oamadon�ka aa�nua0y updabe aar reoor�Ss and reaords af oth��crvemmental ageRaes�+eqaisad by�aarr. 1f <br /> _..... Ycw rerfus�t�SUG�Y the iEr6iortnet1�W13�e a�C�atrp' n m�r ana!be is5ued_�....�„ ._.�..__.._.__� <br /> Q�7�ICdit�`5$igdS2tUf@:�1 �"'�`: _� �--,,.„•, •. d'd4E: 7�/��.1�T 1� .,.... . . ._... <br /> C�� \. <br /> f�uVflBf�S$I�f4H�ufE_ _ ------._._..__._._.__......_..__...._._...�___�..._ �'&�@: --------.�..—. <br /> LaaE tJp€lalcd:.ianuay ZIitB <br />