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' N. ' ,�0� City of Orono . "�.�;'• 'FOIi'CITY°USE!ONLY • Kr�� <br /> � Q � P.O.Box 66 �:Date Aeceived:'�7:�erinit#:���:Z Z <br /> �¢,,��,� 2750 Kelley Parkway ':•..•:..::.•; •.',;�: „�� :`•��•:•.. <br /> ,ay ��°�..,.�� ti Crystal Bay,MN 55323 �•Amount:�� $�• ���� C U P.F�led <br /> ,=-,���$y�� (952)249-4600 ���/. .. . <br /> saxo � . v{ `{'��•.*:Site Plan: :: <br /> � 'Approyed By: • • <br /> ' �`Recommends: .A �roval ��� . Denial �.:�'.'�:'��� �� <br /> CITY OF ORONO -USER DEFINED/GENERAL,PERMIT <br /> (All perniits must Ue approved by the Building Official and/or Zoning Department) <br /> UJob S�te.1�O�er`�or�iiat�on r �L4' y s z ' t' . . <br /> � :e-, f �x.FS�� t . <br /> Site Address: tS S 1p ,� k�..�c� �� . <br /> Owner: ��-S S� S���--�e�' Ma.i.lin�Address: <br /> Ciiy: �r�v�� Zip: � . <br /> Home Phone: Alternate Phone: �� �Z�7 S � ' � `t (j <br /> .1�� <br /> . '�F: �'C.7 ' Y d. F s '^f1F!�� _�'I t'�' <br /> Con�`rac�or�/y`P�P�1�.cautl�orrnatron,4•�, ,,t.,�, >°'�; � €t:- <br /> Gontractor/App.: �G� - ���� � .l��c. Contact Person: . � � �c�.�ar-(z . <br /> Address: 2�l 5 c� 6`1-F � /-�L, State License#: ! �+l 1 l � � <br /> • . City: �oc�`F�,�J Zip: S�3?� ExpirationDate: <br /> Phone: ��`31�7 �� � I 7�. . Alternate Phone: CG(2-1 �G�- G z3�-I <br /> t <br /> ! ��}i� �Gfid�-. r r i''�a.0 I y a ` �3 . ,� .. 'Sti t'1 .-,1�yt x�'�J7dY"�t� 'fi.`�-tt fi�le�y�-j,�� - ... . <br /> . ..�L�._..:�n._�."�'���°:d.:�z�e�f..�}a��.tira� �%5.���i�F.���� r�' I�nPE�.2NLITS.. � 4 -.x�f,`h' n��'�t, :.�i!'c,.�''"f.r°�. . <br /> �[�Stairwav to Lake� � Retaining Walls ❑ Temporarv Trailer <br /> ( Genenl—User Defined Surcharge . Genenl—User Defined Surcharge Genetal—User Defined <br /> * (Per UBC) *(Per UBC) *�30.00 <br /> ' *Estimated Cost:� �� ��� *Estimated Cost: � <br /> 0 Docks—42" or Greater an ❑ Zoning Review <br /> General—User Defined Surcharge � eral—User Defined General—User Defined <br /> ❑ Commercial—(Per UBC) rds *ForO-75'Zone-�30.00 <br /> *Estimated Cost:$ $5 eeds 5ite Plan) <br /> General-User Defined 501+Cubic Yards • <br /> ❑ Residential- $30.00 . . <br /> ❑ Tree Removal . <br /> �� General—User Defincd • � ' ' ' <br /> *Within 0-75'-$30.00 <br /> I herUy apply for a User Defined Pernut and�I aclrnowledge 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 pernut;and that the work � <br /> v�rill be in accordance with the approved plan. <br /> a s��/c�� <br /> Applicant Date <br /> � � f(}serDe6nedPemdt3/18/041 <br />