Laserfiche WebLink
�,�,Q�Q Citv of Orono <br /> Y.O Box 66 f+'OR CITY C1SE ONLY <br /> f � i� 2750Ke]leyPark��°a� Dat�itecci�cd: �G" .=�5/-c��� Yermit� <br /> � j��'�,� ���r��.a��� �t� Cpit�(Bay,MN 5i323 - 1����/��� �5 �� � � <br /> �� �� �7� r�G�, (95�1?�9-460(1 <br /> ���g��,�p�=: � nm�>mit: ����,y; � � > :• r <br /> C.U.! I il�d: <br /> nppro�cd By: ���Sit�Plan: � <br /> P.ecummends: n� ro�al Dcnifil ❑ <br /> CITY OF ORONO - USER DErINED/GENERAL PERMIT <br /> (A11 permits must bc:approved by the^Buildin�Official anc�/or Znning Department) <br /> �n� ��"��t��/,U����ier [nforrr►ation; <br /> Site Address: oZ-�� o1U ��, �-�-.�� <br /> Owner: ��sy l�_�(,��,e.�S�C' Mailin�> <br /> `Address: 3�33 ��;�� �S <br /> City: ��,`�.�^�a�i`5 Zip: 5��{LC7 <br /> , <br /> Home Phone: _� �a.-��{_�`� Alternate Phone: <br /> �ontractor/Applicarzt Informa�ion� � <br /> Contractor/App.: �u����� � <br /> ���� Contact Person: ��e ����,��K <br /> Address: �a� °�-�. ��,� State License #: <br /> ����� <br /> City: �-e�v� Zi b� 1 <br /> �� , �`� Expiration Date: 3�Ut-( <br /> Phone: �SZ-�f <- S 1 1� <br /> Alternate Plione: Le 1 Z�(a gs- al�-(o <br /> TYPES OF USE`Ft�D�FINED PER;�IT�,' ��;' ;,�� �; <br /> ❑ Staiiwav to Lal<e ❑ Retainin Walls �� <br /> General -lJser Dctin�d Surcha�ge Genera) User Detineil Surch•tr�c ❑ Temborarv Trailer <br /> * (PeY UI3C) ` �� Gen�rai.._UserDefined <br /> * (Per UBC) �$30.00 <br /> *Estimated Cost: � x�stimated Cost: $ <br /> ❑ Docks—42" or Greater � Land Alteration � <br /> Gcneral -Uscr D�fin��l St�rchargc ZOT11T1L?ReV1eW' <br /> Gencral.--l.Jscr Define�l G�neral.-.User Uetined <br /> ❑ Commercial—(Per LJBC) 0-500' -$50.00(Nceds sit�Plan� *For 0-77'Lone-�30.00 <br /> *�stimated Cost: $ � 501'+_ <br /> Cieneral—Uscr Defined $�5.��(Needs C.U.P.) <br /> ❑ Residential- $30.00 <br /> ❑ Tree Removal <br /> General....L1ser Defined <br /> * Within 0-7�' -$30.00 Reset Form � <br /> I l�erby apply for a User Defined Pertnit and I acknowledge that the information above is complete and <br /> accurate;tl�at the worl�will be in confonlZance���ith the Or-dinances and Cod�s of the City and��ritll tlie State <br /> Building Code; that I u Zderstand this is not a permit anci w-ork is not to start witllout a pennit; and that the <br /> w r w�ll in � ccorda. ce with the appr•oved plan. <br /> ,\ � <br /> Applic t — <br /> 1� a�`d3 <br /> Date <br /> (lFKcr1:7e1iuklPrunif N�1ti�U�j <br />