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Nov-OB-2010 12:38p� From-CITY OF ORONO +9522494616 T-616 P.002/002 F-026 <br /> � �..J v■ v�v��v <br /> ' Building Permit Application for Internal Work � <br /> (windows; doors� sidin , re-raof, etc. <br /> MaNing Addrass: <br /> �•�� PO gox 88 Permit number: <br /> Q � Crysta�6aY�N►N 55323-0086 bate 1�e�lved: �� C7 <br /> � �'�`` � Sfreet Add�S� Reoehred by; <br /> 2750 Kelley Patkway Plan rev�aw fee: <br /> �! O►ono,MN 55358 <br /> Main: 5�249-4600 F�c: 962-Z49�d816 Tota)Foa: �g• � <br /> This applicaqon i�rm must be completed in f�fl and all�requlred infarrnalion rr►ust be aubmitted. <br /> Incon�pt�ta applicatlons will be retumed. (Please pr�nf) <br /> GENERAL INFORMATION:31�� �O .'�'v1 ��0�( <br /> Jnb Sito Addross: � {"± <br /> iMl!this be a Parade of Homes, Remodele�s Showcase Home or other Display Mame? Yes No <br /> M�a,e aqd�/�vsnt pemM/s�uqvirsd wRA Polia OspaRn�ne ond C�y Counp/eppmw160 deya p�ror!o the o�t S►wnla bus asrwea wl�Y b� <br /> roouirear unbes appllcant asn,onar�ess euAk/ant on-sNe psrlr�ip is avsuebd�. Non-psa,dtroa evanta wiAnof be a/�bwvd. <br /> GONTRACTOR/APPLtCANT II�aRMATION: � <br /> Name: Renewal By Ander�en ' <br /> State License�i 1920 Count Road "C" West � E��on�Dab�: <br /> Phone: Y <br /> Mailing Address: Roseville, MN SSl 13 _ (celil <br /> Corrta�t Person: License#20130983 C� � ZI�P: <br /> Email and/or Fax: � 6S l�264-4777 �t is: Coniractor / Momeowner �cr�we o,,.� <br /> PROPERTY QMINER INFORMATION: <br /> Nan�e: OSo.. <br /> pr,one�aay)� 9�'�—_y� — � -----. <br /> Addreas: ��� C� ZIP: <br /> �mail andlor Fax • <br /> PROJECT INFORNATION: <br /> Typ.of Proiect <br /> An�►oaMh movemeAt may Ioqulre <br /> ❑Door(s) q Remode� , 0 Water damage MCWD ievlew&peRn11� <br /> O�Ni�dow(s) ❑Repair p Storm Dama e ���°�'�Creek Watershed Diatrlct(MCWD) <br /> A 18202 Mlnnetonit8 Blvd <br /> [�Sidin � �zp�v�,MN 55391 <br /> 9 ❑Restoration ❑Othor(sAeciTy) phono: 952-471_pg90 <br /> D Re-�oof Fax: 99z-r71-0882 <br /> ❑Fite DsmsBe �r,minnehohacreek n.n <br /> Over�ll Pro�t Oeswi 'on: ���S ' . <br /> Estima�ed Construation Valuatlo of Pro oet oxdudin IN�d s ' <br /> . <br /> APPUCANT ACKNOWLEDGEMENT: . <br /> • I1�rPe=to provlde aN information�equi�ed or requeatod by the Buflding pepartmenl; <br /> • CertiNes thart the inforrn�tion �upplied IS true and oorrect to the best of his/her lc�owle�e. The Applioant recognizas Ihet the�r <br /> are aolely re�ponsible far eubmittting a Complete eppNca�tion bAing 8ware thet upon tailure tc� do so, the staK haa no al�rnativa <br /> hUt�o re�ed�t untfl it is CorTlplete; <br /> ' 8cme or all of the informatbn lhat you ere eeked fo provide on this appljc�tion ie dasalfied by 8tats law as eith6�prn��e or <br /> confidenUal. Privale data le intonn6don wlt;c►i'Aenarally cannat be a;ve� to the publlc but can ba g�en tp tl�e subject ot Qle <br /> d�b. Confidential Oeta is iMonnatbn wFqch generelly canno� be g;van to eith� the pubGc or Il�e subject ot the dets. Ou� <br /> pu�po6e end infended us of this irnpm�at�pn i� m annually update our reoords and recorcfs oi pther po�rrn�eMal���s <br /> ra wred b laW, li u f se to I the h�fo tlon the ion ma�nat be issued. <br /> � , <br /> Appltcant'e Signat�re; Dete: <br /> L�u Upda�d: OS-04•2008 <br /> Z •d 06i94G9T59 3�IA213S llWb3d Q 9 S f� LT �9T OTOZ SD �oN <br />