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MRY-18-2016 07:46 FROM:TREBILFOUNDATION SYS 3205938720 T0:19522494616 P.3�4 <br /> Name: <br /> Phone(day): <br /> Address: City: ZIP' <br /> Email andbr Fax <br /> PRQJ�CT INFORMATIDN: 2 Q�Q��a-� G� L��CE- p,�I '� �"�l� CZ-�Y {�Q� <br /> Type af Proj4et; Any oarth mo�rvment may require <br /> ❑Door(s} ❑Remodel �Fire f�amage �GWD roviow�psrmits: <br /> Minrtohaha Crook Waturshod qi5trict(MGWA) <br /> Q Re-roof,asphalt ❑Repair ❑Storm D�m�ge 18202 Minnetonka Blvd <br /> [„�Re-roof,ced8r [�Restaration [J Water�amaga Deephaven, MN 55391 <br /> Phnne: 952-471-0590 <br /> ❑ Re-roof,other(apecity� �]Siding ❑Other:(specify) F2x: 952-471-4682 <br /> [�window(s) www.minn8h�haCrBek,orS� <br /> Overall Pro ect Descrlptlon: <br /> Estimated Cons�ructipn VaEua�i4n Of Project(exctuding land) � <br /> APPI.fCANT ACKNOWL�DGEMENT: <br /> ❑ Agraes to provide afl information required or requestod by the Building Department; <br /> p Certlfles that the infprm8tion Suppli�d is true and CorreCt to the best of his/her knowladge- 7he applir�nt recognizes that tn9y are <br /> sotely respansible fqr submitting�complete application being aware that up�n f�ilur�to do so,the staff has np altemative but to <br /> reject it until it 1s Cpmplgte; <br /> ❑ Some or all af the lnformatlon that you are asked to provid� on this applfcation is clasai�ed by State law as either privete or <br /> confidential. Private data is iniurmstion whiCh gener'ally cannot be given to the publiC buf can be given to the subject of the data. <br /> Confldential data Is information whlch generally cannat bo givon to e�thor the public ar the subJect at the dpta, Our purpase and <br /> intended use�f this inform�tion is to annually update our records and r ecxds of ather government2l agencies requir�d by law. If <br /> you retuse fo suppl the information,the a lication rr►a not be issu . <br /> Applicant's Signature: � Date: J✓� ��j d�Ul� <br /> ���� � <br /> L��t Updoted: 08•09-2011 � %� <br /> � �� ����:����� � �� �� <br /> � � ��/� <br />