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� r ' <br /> 4f'�y t�fio��n0 <br /> Buildrng Permit Applic�tion fQr �Ifaintenance / Renovation <br /> {win�ows, doors, siding, re-roof, etc. . <br /> Ma;1ingAddress: Peimitnumber:: . � d ����J � <br /> ��� PO BOX BB ' ' �, . .� ., rl � • <br /> a Q �rystal Bay,MN 55323-4066 aate,rec�ived:� <br /> Reoe'rved br. � . <br /> � �' i s�t��rd�: . . . <br /> ` 2750 Keltey F�rkway ' PI'an review'�e: <br /> � �,� I Qrono,MN 5535� � <br /> .3ota!Fe�: ,/'� ,�� <br /> Ma9n: 852 248-a800 Fax: 952 249-4G1i '.uro .mn. � <br /> This application fo�n�must be co►r►pleted in full and all required infomlation must be submifted. <br /> lndomp��te applic3�lons will[�e retumed. (please prirrt� <br /> GEN�RAL fiN�CRMAT'lON: �in �j n�, � �'-�. ��►t�-�.� <br /> Job SFt�Adctress: N ( i v <br /> Wiil f�'�ts be a Parade of Home�� eiers S[�ow��''�Hcme or otlter DEsplay Homs7 Yes No <br /> !i ye5,a speC[af eve»t pen►dt Ls requl wiPh Poltce Qep�rfinenf and CKY GoUncr!appli►val BO d�ys p1�or fa fhe eveM. Shut�(8 bus servlce wlll be <br /> !���g���s�t'1ols�on�slfe parklr+g i�evaDable. Nori-Agmri[ted everl�wtll no!be a!lowed. <br /> r�gulred unlesa eppl <br /> CONTRACT4R/APPLtCANT IN�jt�RMATION: <br /> Name: ���f�'1'a'�'�.�5�'� EXpitation Date: '�i 3 i <br /> State L.ice�# �1��'3� 3 Expiratian D�te: <br /> Lead Certficatlon Number: � -� c� c�S3 � y1��'�' <br /> {for Wo�lr orr hom�s�f�re� sti'v�i�d AriQ►'to 7.87�tofFi�e) (Cell} <br /> Phone: ta5t-� �! �4•4$�'" Z(P: $S I r3 <br /> N{2�tling Address: � p � 1 •• •• W��!" ��� ► � <br /> Cr�ntac#Person: � ApPlicant is: on cto / Homeovvner �c�a,e1 <br /> Emsil�nti/or Fax: <br /> PRdPERTY OWNER 1NFORl�4A iON�`� r�G���� <br /> Name: ti <br /> Phone(day): c�- '�' Z1P: <br /> A�ddress: ��ty. ' <br /> Ema11 andlo��ax , <br /> PRQJECT lN�QRMATION: Any ea�rth movement�ay r�qulre <br /> Yype of Frojeata MCWD revie�n►�permifs: <br /> Q p�t�� ❑R odel �Fire I��cnaga Minnehaha Creek W�tershed Distric�(MCWD) <br /> 1$Zp2 Minnetonka Blvd <br /> L!Re-roof,sspha[t ❑Rep3ir ❑Storrn Damage De��en.MN 55391 <br /> ❑1�roof,cedar �Ra�toratbn ❑Water Da►nage Phone: 952-471�590 <br /> Q Re-roof,ather(sPac�fj►) ❑Si��ng Q Other:(speolfY? Fax: g52-47i-U682 <br /> www.mEnnehahac eelc.ors <br /> ❑WinBow(s) • � <br /> r f " <br /> Qverall ProJ�ct De�cr�p�i�n: � - <br /> Estimatsd Constructiori Valu o of Pro�act(excluding far�d) $ j <br /> APPL(CANT ACKNOWLEQ EMENT: <br /> . Agre�s to provide af1 info �ort required w requ9sted by the�u'slding Departme�nt: . <br /> . Certlfies that the fi[ifamna n suppfied is�ue and li�ca�'an bei�atnPar�that upoowled�to do�5n.�th�ensteff h�ssnnO�sitem�y . <br /> are solely responsible for ubmltting a c�mplet��pp 't9 . <br /> but to rejer•t it untt!it is co pl�te; <br /> . Som�s or aft af tk�e info on t�at yau are asked ta pr�►ide on thi5 epp(�an i�dass�ed by State iew as either privs�te or <br /> corfidentiai. Private dsta ' informatton whlch generally cannot be given ta the pub{ic but can �given to the subJect of the <br /> data. Corfidential data i iriform�flon wi�tCh 9Q����Y �n�t be given to elther th� pu�tc or the subJect of th� data. Our <br /> purpos$s�nd ir�enderl use of this iniormation!s to annu�lly update our rewrds and rec�rds of other'gnve�nmeni�al agendes <br /> ulred b law. ft refuse to su the information,the a lic.��ot►ma not be issued. <br /> Date� ���� �� <br /> A�olicar�#s Si�natttre: <br />