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0 City of Orono �, „�„�, FO ITY USE ONLY <br /> 0¢ �0 P.O.Box 66 'WII'I-!,Y/ /( Date Received: -7/ dir,7 Permit#/4 I/�1 <br /> eta 2750 Kelley Parkway l ``� <br /> - a ? E* Crystal Bay,MN 55323 'f'2' Amount: $ 460'iV C.U.P Filed: <br /> 1. 4. <br /> k S,°` (952)249-4600 <br /> SAO <br /> frApproved By: Site Plan: °.S•2-6 7 <br /> Recommends: Approval Denial 0 <br /> G� IJiSfnl.so/0-'S %,.l+n-+ � vR, ci <br /> CITY OF OR NO - 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: " <br /> �� C Cot R-/ T / AcA,Vc/ `.� .- ,�& <br /> Owner: J-`/n ,rnQ4 '\-'.50/J Mailing Address: jsy zne <br /> City: j-(fvnJ Zip: 3-75-3z/ <br /> Home Phone: Alternate Phone: f`7-f/'" F7 7 3 <br /> Contractor/Applicant Information: <br /> Contractor/App.: r!;cCvi 1 e AvJSetxPc Contact Person: 1/qA) <br /> Address: /G / 5 5- S State License#: 4/. f1 <br /> City: 4-- <br /> +.vF e Zip: 5 6 y Expiration Date: /11. 4 <br /> Phone: 6()- i2/ 4773 Alternate Phone: ra oc—ci---- <br /> TYPESOF USER DEFINED PERMITS <br /> X ❑ Rettairway to Lake <br /> S <br /> aining Walls ❑ Temporary Trailer <br /> General-User Defined Surcharge General-User Defined Surcharge General-User Defined <br /> *(Per UBC) re * (Per UBC) * $30.00 <br /> *Estimated Cost: $ ?,5-0----- *Estimated Cost: $ <br /> ❑ Docks—42"or Greater ❑ Land Alteration ❑ Zoning Review <br /> General-User Defined Surcharge <br /> ❑ Commercial-(Per UBC " 1' �J � See <br /> t '` , <br /> *Estimated Cost: $ /'� f c l v ct i-J /"3- <br /> General-User Defined <br /> ❑ Residential- $30.00 p.,e,„ tivu,,,7---- -, ii )/1--e --'2'6 <br /> ❑ Tree Removal <br /> General—User Defined ��� 1/Y--- .5✓1 S <br /> *Within 0-75' -$30.00 ! <br /> - ..PC.) .1 <br /> I herby apply for a User Defin <br /> accurate; that the work will be ii <br /> Building Code;that I u derstanc <br /> will be in accorda.' : with thea <br /> Applicant ,amu«, <br /> (User Defined Permit 1/I S/041 <br />