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FROM :CONCEPT LANDSCAPING FAX N0. :952 472 4119 Jul. 22 2004 11:29AM P5
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<br /> 27501Lailoy Parkway i�47el'h,� �iLL� re i; :�i•y,+�F, ..:Y,,'j_�1.1:1'x �"..�, ,•.. s:c
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<br /> CITY OF ORONO- USER DEFINED/GENERAL PERMIT
<br /> (All permits[Ener be approved by the Building Official iustl/nr7nn{ng Doparrtnmt)
<br /> k,<a s:,,l sianll.ltk"r Ifn•46,12%Nat :.r.,1, 7Tiritf."i n
<br /> Site Address: 1200 WILDHURST
<br /> Owner: HOLLENHORST,MIKE Mailing Address:
<br /> City: ORONO Zip: 58364
<br /> Home Phone: (812)860-4807 Alternate Phone:
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<br /> Contractor/App.: CONCEPT LANDSCAPING Contact Person: JIM SMITH
<br /> Address:
<br /> 3153 PRIEST LANE State License#:
<br /> City: MOUND Zip: 55964 Expiration Date:
<br /> Phone: (952)472-4118 Alternate Phone:
<br /> t �. M. i�anh,rt fury>tik a+,k e4t•+� ;;.nt
<br /> 0 Stairway to Lake ® Retaining Walla 0 Ternporary Trailer
<br /> Genial—Um'Defined Surcharge General—User Defined Surcharge General-User Defined
<br /> *(Per UBC) *(Per!IBC) *$30.00
<br /> *Estimated Cost:S •Estimated Cost:$
<br /> ❑ Do2ks—42"or fireater ❑ lamtAlteration ❑ Zoning Review
<br /> General—User Defined Surcharge General—User Defined General -User Defined
<br /> ❑ Commercial—(Per UDC) ❑ 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_r.)
<br /> ❑ ' 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
<br /> work will b '(„5.7rdance with e a yed plan.
<br /> Applicant Date? /azI°'-(
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