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ri"...- -\ City of Orono FOR IT USE ONLY /0\ P.O.Box 66 Date Received: Permit44// 5f3 <br /> c 2750 Kelley Parkway <br /> 1 ?- ' Crystal Bay,MN 55323 <br /> t'MINN CV (952)249-4600 Amount: $ C.U.P Filed: n <br /> Ji <br /> Approved By: elf. Site Plan: <br /> Recommends: Approval Le Denial ❑ <br /> CITY OF ORONO -USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site/Owner Information. <br /> Site Address: 9g 5- W►l/ew View 13r►'vse <br /> Owner: Lou d't1 A ry Fibs Mailing Address: g 23 W►'//ow View Or/*v•( <br /> City: 0(rim v Zip: 55-3 3 3 .0 <br /> Home Phone: 75-3,- 9 3 - O a y3 Alternate Phone: 6/a - 18/- A 906- <br /> Contractor <br /> 06Contractor/,Applicant Information: <br /> Contractor/App.: T 1^^ H0 rr1•Sam Contact Person: S4?1,-P <br /> 01,44.crF fav''`' <br /> uh.1 Address: State License #: <br /> + Ua <br /> NUS 1S 'City: U rThon v Zip: 5-5-3 5—C Expiration Date: <br /> Phone: CO— 363- C 9 qC Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS' ' :.:' <br /> E Stairway to Lake ❑ Retaining Walls E Temporary Trailer <br /> General-User Defined Surcharge General-User Defined Surcharge General-User Defined <br /> *(Per UBC) * (Per UBC) *$30.00 <br /> *Estimated Cost: $ *Estimated Cost: $ <br /> ❑ Docks—42"or Greater and Alteration E 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 ,e4e.e.„ <br /> f/4 <br /> I herby apply for a User Defined Permi I acknowledge that the information above is complete and <br /> accurate;that the work will be in conforl nce with the Ordinances and Codes of tl City and with the State <br /> Building Code; that I understand this ' not a permit and work is not to start witl ut a permit; and that the <br /> work will be in accordance with the pproved plan. <br /> Applicant Date <br /> Reset Form (User DeEned?emit 3/18/041 <br />