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1 � <br /> "• ��� 1 �,.. <br /> i �,,n� �� <br /> � �- � p��„ City of Orono � FOR CITY OSE ONLY � <br /> ,1�¢ �,�'+ P.O.Box 66 � Date Received: � � � Permit# �'��''�� �-, <br /> 2750 Kelley Parkway <br /> '� 11�'�' ��;� Crystal Bay,MN 55323 �" c <br /> "���r�p4�o�,� (952)249-4600 ��� mount: $ J`�� ' �C.U.P Filed: <br /> ..__ '. APProvedBy i/FE� 9ri�FEn:�'�6'�� <br /> Recommends: A roval 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: U�� �Wln IZOG� I`4�L,TVI , DI/�✓�� <br /> Owner: MA�I�� �►N' IS �X.VIWAI�ZV�Q�I� Mailing Address: Z�O UnAA WDD� u1� <br /> �A '2� M��9/ <br /> c�ri: z►p: <br /> Home Phone: `�I,J2' �1�•1 IZ� Alternate Phone: <br /> Contractor/Applicant Information: ��0� �f�� <br /> Contractor/App.: �e Ncth�� b►�u� Contact Person: n Y�ly ���1�I 1'Y) <br /> Address: � N � ST Su���� State License#: <br /> City: �S Zip: �7�� Expiration Date: <br /> Phone: �I2 ��� �`'�� Alternate Phone: �Z• I-la•�� I � SC.QII <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairwav to Lake [� Retainin� Walls ❑ Temporary Trailer <br /> General-User Defined Surcharge General-User Definzd Surcharge _ General-User Defined <br /> *(Per UBC) *(Per UBC) �" ����� *$30.00 <br /> *Estimated Cost: $ * Estimated Cost: �� <br /> � a� E-�] Docks-42"or Greater � Lan�l Alteration ❑ Zonin�Review <br /> In At W i w �,� General-User Defined Surcharge Gener2l-User,Defined General-User Defined <br /> ru�� f^ � Commercial-(Per UBC) '�f 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> M�inn. e� * EStimated Cost: $ $50.00(Needs Site Plan) <br /> Wa�rs�d General-User Defined Q-501+Cubic Yards <br /> ❑ Residential- $30.00 ,�" $50.00(N�eds C.U.P.) <br /> ��S�l'I�� ,�' e ov f <br /> �� L�wiC , e eral U er fineb r ` <br /> i P� ) ',,�* i in ' -$��0 <br /> ��� � )('' � l_�''� ���r r� � �1�� <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 unders this is not a permit and work is not to start without a permit; and that the <br /> w 'll be in a c r ae ith,the approved plan. <br /> " ' `� �.7-0+� <br /> ica t Date <br /> Reset Form (UserDefinadPamit3/IS/04) <br />