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0 City C FOR SE ONLY <br /> 0 0 P.O.BC Date Received: Permit <br /> 2750 K <br /> Crystal Amount: $-1'— 3C.U.P Filed: <br /> (952)% <br /> Approved By: Site Plan: <br /> �1 Recommends: Approval ❑ Denial ❑ <br /> CITY OF UKurm"- EFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Site Address: 817 a^ k-^w^ Ro�� <br /> Owner: -��%5 �-� Slaw.. y.,; Mailing Address: /o ESA. t:s, <br /> City: Zip: 5533 / <br /> Home Phone: (9'5-z 7`/- 318 Z Alternate Phone: <br /> TV <br /> Contractor/App.: Contact Person: T► � �''^'�4 <br /> Address: i o-7o c v F Ewe S 5 3 r z State License #: <br /> City: Zip: 55 YY/ Expiration Date: <br /> Phone: 6�t 2 -7 15 3 3 3,C Alternate Phone: 3 5 Y Y Soo Z <br /> Stairway to Lake Retaining Walls ❑ Temporary Trailer <br /> General—User Defined Surcharge General—User Defined Surcharge General—User Defined <br /> *(Per UBC) *(Per UBC) *$30.00 <br /> *Estimated Cost: $ /Z"000, ' *Estimated Cost: $ E,,o00• CI`, <br /> ❑ Docks-42"or Greater ❑ Land Alteration ❑ Zoning Review <br /> General-User Defined Surcharge General-User Defined General-User Defined <br /> ❑ Commercial-(Per UBC) ❑ 0-500 Cubic Yards *For 0-75'Zone-$30.00 <br /> *Estimated Cost:$ $50.00(Needs Site Plan) <br /> General-User Defined ❑ 501+Cubic Yards <br /> ❑ Residential- $30.00 $50.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> General—User Defined <br /> *Within 0-75' -$30.00 <br /> I herby apply for a User Defined Permit and I acknowledge that the information above is complete and <br /> accurate;that the work will be in conformance with the Ordinances and Codes of the City and with the State <br /> Building Code;that I understand this is not a permit and work is not to start without a permit;and that the work <br /> will be in accordance with the approved plan. <br /> ell <br /> Ap cant Date <br />