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' . ' Ci of Orono . :r�; ' :� K„'�
<br /> ,g,0,�, f3' : FqR CITY°USE ONLY f�
<br /> " � P.O.Box 66 :Date Received .��7 Permit# ��T `
<br /> ��°�`,� �� 2750 Kelley Pazkway :� '�, �. ,.
<br /> C stal Ba MN 55323 j
<br /> �. b��; .,,�'-• .� �1' Y, Amountr . :.•$� �-��� . •C.U.P'Filed: � .'
<br /> w�t�'�B$c+` (952)24911G00 • - / •Y .. .
<br /> • �� • �`�'O`'�'r:'Site Rlan: ::
<br /> �Approyec]By: •
<br /> . . :`Recommends: .A �roval .[/� •. � Denial.��...:.,'.` •. `��
<br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT
<br /> (All pertnits must be approved by the Building Official andlor Zoning Department)
<br /> �
<br /> 7ob�S�te 1�Owuer�ornlation- �$�:� _r '�,*;� , Y� .
<br /> r., .�..�... ..,. .., . � . .. _�,.,. ...._. ,�_,...�,�,__ ...... _.. .,�:
<br /> Site Address: CS S 1a ,� kc.�,G,, �v .
<br /> Owner: ��-SS� 5����e r Mailin�Address:
<br /> .Ciiy: �J`�v�� Zip:
<br /> Home Phone: Altemate Phone: C� �Z�7 S � ' G `� f-�
<br /> �Con�'ra��oi��y��p.�?�cant7�fo,rinafiion"na�,y``���Z �'s�, t�
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<br /> ..,.a..�.i.... . :.x_. �. .o. ...._.....�-s�,.�!..,.�? >.:e�' .
<br /> Contractor/App.: ��'� — ��,� �L�c. ContactPerson: . � a ���.�a.r-lz .
<br /> Address: 2��v 6`�f �- /-�-v�, � State License#: ! �/ 1- � �
<br /> � . City: �oc--�-�.��,�� Zip: SS3?� ExpirationDate:
<br /> � Phone: . ��`31.�7�-' � I ��. Alternate Phone: CG �2--� 3G�- G z3��
<br /> . . �
<br /> . . � �:}d� +f� c�. x�'°" �- ii f�, v����,��, `• �+c f- .'." c.� ,�� ..�1 .r� aa��t �'CL��� }-f"�✓'�A , . . ... . �
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<br /> , ..,4�.�.,.::a._).'.4,;t...�.,;tiz-`s�..�)�.,.:ti::�dt .���L�L�7µOF.IJ�'�R�DFFII�D�.pE�1kIt�I'�,.,:,.�� � �.a j�inr�5�,�:t,7"�,,��t��:��bXrn�,
<br /> �Stairway to Lake ❑ Retainin�Walls ❑ Temporarv Trailer
<br /> General—User Defined Surcharge . General-User Defined Surcharge Genetal—User Defined
<br /> * (Per UBC) *(Per UBC) *$30.00
<br /> " *Estimated Cost: $ D�� *Estimated Cost: �
<br /> 0� Docks—42"or Greater an ❑ Zonin�Review
<br /> General—User Defined Surcharge eral—User Defined General—User Defined
<br /> ❑ Comnzercial—(Per UBC) rds �*ForO-75'Zone-�30.00
<br /> *Estimated Cost:$ $ eeds Site Plan)
<br /> General—User Defined 501+Cub1c Yards •
<br /> ❑ Residential- $30.00 . .
<br /> � ❑ Tree Removal ..
<br /> � General=User Defined • ' - ' "
<br /> *Within 0-75' -$30.00 � . �
<br /> I herliy apply for a User Defined Pernut and�I aclmowledge 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 understand this is not a permit and work is not to start without a peimit;and that the work
<br /> will be in accordance with the approved plan.
<br /> s��/�.�
<br /> Applicant Date
<br /> � 7UsecDe6nedPem:t3/18lOat �
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