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Jul-27-2011 06:54am From-CITY OF ORONO +9522494616 T-077 P.002/002 F-219 <br /> city of Orono <br /> Building Permit APPIICatian for Internal Work <br /> (vwindowsd r , sidlng, ro-hoof, ete. <br /> Mallin,gM*McPecmitttrir�itaer:. .' l ' • <br /> 1, 7711 <br /> QPtd t3orr 66 <br /> crystal Bay,MN 56=3-OM Dataa rerceive+i: <br /> SrrewtAddrass: ReeeLVGd <br /> c� 2750 Kelley Parkway ATan nwi tee: <br /> orono;MN 55 <br /> Male: 9524A9.46G0 I:= SM-246461j5 )"ffltd.oronu. us <br /> This apps 'ran form must coma Bteal in full and all requirli nIbITMOon must be sunmrtted. . <br /> 1nempleb appilmdons will be eattmmed_ (Rose Ont) <br /> CgMsP.AL INFORMATION: �,C)15 � ��,►^� • — <br /> Job Site Adds : ,� No <br /> Will this►he a Parade of i•lomee,Remodeisrs Showcase Home or other b-16-010Y HOntea 9 Yes <br /> y y�a ehrent pama�is r va+ttlr Police Depa►bneratM d CAY CC WrcN$pprraver BQ"v Pr"the evara'. Shtdtla tars w lra <br /> rhea tNrs ate'oernans�rstes srlAlaler�t once ParkvtgPS mv�abre. �a+�atrts wtlfred`ba allowatL <br /> CONTRACTOR I APPLICANT INFDFAATI <br /> Nmnw. t <br /> Smote Licer+so# Expiration Date; <br /> Lead Certifirgon Number. '��- l = -1 Expiratlon[ate: la <br /> i I it <br /> �yw*an homes drat were cD-nStr atmPrtorta I= <br /> Phone: Rst-l <br /> city: ZIP: <br /> McAlrtg Add—s' <br /> contact Applimnt is: OlttraCto ! Home wiNner (ciM@ o* <br /> Em.all and/or F='x <br /> PROPERTY OWNER iNFORMA <br /> Nana: <br /> Phone(day): city.uton 13 ZIP: <br /> Addrew• <br /> Email ar <br /> 'ROJECT IWFORNu47lC1lri; Any v*M movmentnray roquire <br /> Type°r MCWD ret►leW&permits. <br /> ❑Eloor(e) ❑Remadel Q Water image Vmnehaha Cra"Watomhed Disbar(MONO) <br /> Blvd <br /> Window(s ©) Repair Q storm image 18202�yan,1u�1Unnein� <br /> MW <br /> ®Siding 0 Restxafflon Q Other.(speofi+l) Phws: M-471-OND <br /> ' mof Q <br /> Fire pasr.age R= �7LcjM� <br /> awermu project nescrodon: <br /> g Constrito#ion Wivaian of"ea(ex rluding land)--- $ <br /> APpL cMT,ACKNOIRUDGEMENT: <br /> Agrees to provide all irdbrmation required or requeeted vy the Building Depar mml: <br /> Certiiigs that tit8 iRfommoon supplied 1s trite and correct to the best Of his mr UnDw add, Th®2PPff nt recagnta�first�3I <br /> am Gowly MP96 ibr submitting a complete appticsiaon being aware that upon failure to do so,the doff has no atirsmat" <br /> burro reject it until it is 0orn001e; <br /> Some of ail of t o inforr oon that you are asked to prcmde On this aPpiie�tiorn is dessified t►y taw®s�ttlner ad a or <br /> emagarbal. Pswe data is irtl =Mtn which generally cannot be g1 wn to.the public but can to 9�to tits subject of the <br /> data,. Conftdenu dws is inibtmation which ganernlb cannot be g""Wren to alther the pubiie or the subject Of the dsfia. Our <br /> pgnme and intended use at this;inormedon is m annuM update cur records and nrcords of other 9014ernmentid agwc <br /> mDOW M. iaDs t on e <br /> AppGca s sisru3turix ---- <br /> Gaal Med: =1142M1 <br />