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� � ,¢��, City of Orono FOR CITY USE ONLY <br /> �� � P•O.Box 66 Date Received: �/-�-�:,r� Permit# � �l � <br /> r„�, 2750 Kelley Parkway �C�� ;? <br /> ���Z � Crystal Bay,hi�(55323 Z��, � '� <br /> � Amount: $ � " � �.U.P Filed: <br /> �o$f (952)249�600 <br /> Approved By: 4��� Site Plan: <br /> Recommends: A mval Denial ❑ <br /> (.v/77`f N o7�5 <br /> CITY OF ORONO - USER DEFINED/GENERAL PERI�IIT <br /> (All permits must be approved by the Building Official and'or Zoning Department) <br /> Job Site f�Qwner Infoiinahon ��. }� ��������.a;.: <br /> .� <br /> Site Address: 2 8�� G��� �• U� <br /> Owner: WI�4v ���""� Mailing Address: �7 ���i�� � � <br /> City: �OD�� Zip: 0�1� t"j$�j� � <br /> Home Phone: _ ���'�7 7�p Alternate Phone: �l� ' S�p C� � �(�O,j ( <br /> Contractor/Applicant Information: <br /> Contractor/App.: J�n� I�I�.J Contact Person: �f� <br /> Lf�1��G��--��I�-- <br /> Address: State License#: <br /> City: �3��L'�1`�IOI�-- Zip: �'S�✓ ( Expiration Date: <br /> Phone: R s� '���"' '���'�i Alternate Phone: ____1� - ��, <br /> �r_2- � <br /> ' �� ; r �� �� K�a � t �`r `,�� `.r�`...�,.. '^s... <br /> ��� �'�'� `' �� �� TYPES.OF USER DEFINED PERMITS � � ;� <br /> �t�; �-� �;., <br /> � Stairwav to Lake ❑ Retaining Walls ❑ Temporarv Trailer <br /> General-User Defined Surchazge Ger:eral-User Defined Siucharge General-User Defined <br /> *(Per UBC) *(Per UBC) * $30.00 <br /> *Estimated Cost: $ iSd�'� *Estimated Cost• S <br /> ❑ Docks—42"or Greater ❑ Land Alteration ❑ Zoning Review <br /> General-User Defined Surcharge Ger,eral-User Defined General-User Defined <br /> ❑ Commercial—(Per LBC) ❑ 0-500' -$50.00 (�eeds sice Plan) *ForO-75'Zone-$30.00 <br /> *Estimated Cost: $ ❑ 501' +_$�5.00(\eeds C.U.P.) <br /> General-User Defined <br /> ❑ Residential- $30.00 <br /> ❑ Tree Removal <br /> General-User Defined <br /> *Within 0-75' -$30.00 <br /> I herby apply for a User Defined Pernut and I aclmowledge that the information above is complete and <br /> accurate;that the work will be in onformance�zth the Ordinances and Codes of the City and with the State <br /> Building Code;t at I underst �s is not a permit and work is not to start without a permit;and that the work <br /> will be in accor with n. <br /> i <br /> A hcan _ 'v 4 V ' <br /> PP Date <br /> t���ae <br />