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0,���0 City of Orono FOR CITY USE ONLY <br /> � P.O.Bo�66 Dzte Received: Permit� <br /> �;�.,,,,, 27�0 Kelley Parlcway <br /> � ij��'?:�:�'. � Cr stal Bz MN 5�=2= <br /> � 1:i.,t�',,: � Y Y, Amoun.: � C.U.P Filed: <br /> `�t"�(�f�j'���,�,r �952)2a9-4G00 <br /> '�"sexo�`� Appro��ed By:��>��� Site Plan: <br /> Recommends: A roval Denial ❑ <br /> CITY OF ORONO - USER DEFTNED/GENERA.L PERIVIIT <br /> (AI!pennics mus�Ue appraved by the Buildi��Oificial and%or Zenine Department) <br /> Job Site/O��Zler I�ifornlation: <br /> SiteAddress: ��%�.� �����;�t<<��:y-� � ���� (' <br /> Owner: �`l� � � � j�' f'��.��� Mailin� Address: ��� � <br /> City. ����<�� (i Zip: <br /> Home Phone: Altenlate Phone: <br /> Cont�-actor/ Applicant Iufornlation: I <br /> ��� � �� � � ��,�� �� '� � i`�� - <br /> Contractor/App.: (����i�� ��r c� «t� � Contact Person: ����� �z''�/�l�l� <br /> Address: l ���i' �t/c��2���i (�I v� • State License #: �G -' 7Z-� � <br /> City. �l/c�,� zcc�l't Zip: SS-��?� Expiration Date: � ' � � ' v � <br /> Phone: ��� ' �l������ � Altei�zate Phone: ��Z � ��� - � S�6 <br /> TYPES OF USER DEFINED PERNI�TS <br /> ❑ Stair���ay to Lalce ❑ Retaii7inQ Walls ❑ TemUorarv Trailer <br /> General—User Defined Surchar�e General—User Defined Surci�a�oe General—User Defined <br /> " (Per LTI3C) * (Per UBC) * $30.00 <br /> *Estimated Cost: �, *Estimated Cost: S <br /> ❑ Docks-42" or Greater �J/ Land Alteration ❑ Zonine Re��ie��� <br /> General—C1ser Dztined Surchar�e General—Us�r De'ined General—User Detined <br /> ❑ Conunercial-(Peo� UBC) �0-�00 Cubic 1'a�ds *ForO-%�'Zone-�30.00 <br /> '` Estimated Cost: � s50.00 (Needs Si�e Pfan) <br /> General-Us:r Delined ❑ 501+Cub1C Yal'ds <br /> `� Residential- �30.00 ��0.00 ('.eeds C.u.t�.j <br /> ❑ Tree Remova� <br /> Gene;al—User Defned <br /> � �'ithin 0--�' - 530.00 <br /> I he:by apply for a User Defined Peizr.it and I ack7:owledQe fna? the iniornlation above i� complete and <br /> accurate; that the work«�iil be in coniorniance�vith the Ordinances and Codes oi the Cit�,� and�vith the State <br /> Building Code;that I unders?and this is not a permit and�vork i�not to sta�witnout a per.mit; and that the work <br /> wiil be in zcco�dar.ce witn the aporoved plan. <br />