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SE�'-13-c�10 96:11 FROM:ESTHERS PERMITS 6513300894 T0:9522494616 P.1�2 <br /> City of Orono <br /> Building Per�n�t Apptication for Internal Work <br /> (windows, doo�s, sidin � re-roof, ete.► <br /> Mai!!ng Addrsse: PerrNt rwmber: o��/f�'bd �l7 <br /> (��Os rQ Crym�l6o�y.MN 35923-0088 G�e c+ecehrod: q�/c�J'�I� <br /> Stresl Add�ss: ����' <br /> ��. � 2750 WBsy P�A�aray Rlan rev�wtee: <br /> '�t+ Orono.MN 55358 ,, <br /> ra��Fee: �Lj,�7 `j <br /> Metn: 85Z-Z�9-4600 Far. 832 249�a81e warw.�ci.oror�.mn.w�s <br /> Tnls appllc�tton roRn must De eorr�plete0!n 1ui!ana an requl�lntbrmation must be submitted, <br /> Incompfem�ppl[c�Uona w01 b�returrned. (P/ease pn'rrtJ <br /> GENERAL 111f�ORl�IATION: <br /> Jo6 SHe Addres�: 424Q North Shore Drive <br /> Will ihis kre a Par�de of Homes, RemoDelers 3howcas�Home or other Oispl�yr Mome7 Yos (da <br /> Iry�a,o sp�eJal w�ntprro��f f�r�quksd wl�h Polle�Cl�pahn�n!uM Cey Cowia7�pro�ad 68 da}+a�Jo.te fha.Ned Shu(d�6�a s�t� !r <br /> �v�u/rod w►lesa a1a�plJc+r�demonatrsEss a�dlPdent a►►,olte Ferkt+i0��velleDfs fYo�pampA�e�ta wlArntea sRawbe. <br /> CONTRACTOR/QPPIJCANT INFOR�TION: <br /> Name: PYo9uilt Amer c� <br /> 8tate ticen9e# Expi�a�on Date: <br /> Phone: - - (o�ica) (cep� <br /> Maltirt0 A�dress: �'2Z'Z'�i've ."_ Clt : �- -, s� ZI'I""_'p�'i� <br /> CoMact Pe�son: App icarrt is: Cen ct�� / Womeawner tr��e�l <br /> Ema�anNorFa�e eat erd�w ndowwor dma.com-65i-77�-0495 <br /> PROPERTY OWNER INFORBAATION: <br /> Name: P��er 8chwa�ctzkop£ <br /> Phon�(day). <br /> Addr�ess: s me a� a e Cit�r. ZIP: <br /> Email andlo�Fax <br /> PRdJECT IN O ON: <br /> Yype or� , A�,y e�Al,moMe,ner,t�r reoulre <br /> MCaYD review�p�rmits <br /> ❑Door(s) ❑Renmdel p wpa�r Damaee <br /> �nnmhoh�Cresk Vll�fer�hed D"�t 1AACUW) <br /> I�I'Window�sj ❑Rspair ❑SOom�Qarrupe 1820.Z Minnstonl�8Nd <br /> Oeephe�ron,MN 55381 <br /> ❑SidinO []Res�oration ❑Other:(spacify) Phone: S52-a7t-05@JO <br /> Fax; 8:�2�471�0882 <br /> ❑Re-rooP ❑Flre damepe �,roiee hahaaraek.aro <br /> OvOrall Pro�ectDescript�on: R�placinq 1 win�ows not chanain9 size <br /> rr� ■�� •��r��� �■ r r���� �w��.�w <br /> �mated Cc�ns�lon Vmtuadon ot pro�c�t��c�lu�ing t�nd� s 746 � <br /> APP,L,,,,�ANT ACKNOWLED�EMENT: <br /> . A�r�ses to provid0 aU mfom�tio�requlrsd ar�queshsd by ihs�uildit�08pardnonC <br /> . CardAos�ot�o Infomnotlan euppq�d Is a�o ond oa�raex te th�b��t ol Alalher kRowAsd�. T�s s�luane raeapnLzse�hai ihAy <br /> are aolely recponal�ae ior subml�lnp a oompEe�apptkatlon beln�aw�re that upan 1�Ilure eu oo�o,ms e�atf ha4 no ahema�ve <br /> but Eo roJaet it ur►dl it is oompleb; <br /> • 6orr�or oU of ths inlormaiio�lhat you aro omkmd io p�ovide �this�ppli�n ia dai�ifi�d by S'��s law a4 oiih���iva4�or <br /> oonNdendol. PrivaEa dam i�Inlbmrotlon whkh penerally cannot bs Siven eo d�e publk but a�n be piven eo the sudJact af q�e <br /> d�ts. Corfider��I da�o Is irifor►ru�Nen which genernily canr�o�t he ah+en ta Nfhet ihe puttliC o�Uw sub,�tt of the data. Our <br /> purpa�e �nd ir�ndad u�e of thi�iniormadon�E�nrowatly upd��our�co��nd �ords of other povammer�nl apendes <br /> uirsd h taw. If ou ra�fuss ni ths ir�fortr�tbon ths a titation ma not be I�usd. <br /> Appi�ant's S{pnatute' �� �/ , , Oata� 09I13/].0 <br /> L6�'NpdetOd: O:F�-20C0 <br />