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`0�1� City of Orono FOR CITY USE ONLY } <br /> , ;j�¢ `��r P.O.Box 66 Date Received: ,, -5�,� Permit# �U�l���� <br /> `' 2750 Kelley Parkway <br /> ( �,".- + C stal Ba MN 55323 O�0 d <br /> y'� �`�r��:vy��i� (952)249-4600 �� Amount: $ 7�f3. �0 C.U.P Filed: <br /> �asxoe �.� <br /> � <br /> Approved By: �•!. Site Plan: 6- �.Q <br /> Recommends: A roval Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (/�II permits must be approved b��the E3uildine Official and/or Zoning Deparlment) <br /> Job Site/Owner Information: <br /> Site Address: 2920 FOX STREET <br /> Owner: CHAD ABRAHAM Mailing Address: 2920 FOX STREET <br /> City: ORONO Zip; 55356 <br /> Home Phone: Alternate Phone: (650) 898-9476 <br /> Contractor/ Applicant Information: <br /> Contractor/App.: KEENAN 8� SVEIVEN, INC. Contact Person: KEVIN KEENAN <br /> Address: 15119 MINNETONKA BLVD. State License #: 7252 <br /> City: MINNETONKA Zip: 55345 Expiration Date: 03/31/07 <br /> Phone: �952) 475-1229 Alternate Phone: 612-328-2560 <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairwa� to Lake � Retaining Walls ❑ Te�nporary Trailer <br /> General—User Defined Surcharge General—User Defined Surcharec Gencral—User Defined <br /> * (Per UBC) * (Per UBC) * $30.00 <br /> *Estimated Cost: $ * Estimated Cost: $ 30,OOO.p <br /> ❑ Docks—42" ar Greater ❑ Land Alteration ❑ Zonin� Review <br /> General—User Defined Suroharge General—Uscr Defined General—User Defincd <br /> ❑ Commercial—(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-�30.00 <br /> * EStlmatCd COSt: $ $50.00(Needs Site Plan) <br /> General—User Defined ❑ S��+CUb1C�'aCdS <br /> ❑ Residential- $30.00 $50.00(Needs C.u.P.) <br /> ❑ Tree Removal <br /> General—User Detined <br /> * Within 0-75' - $30.00 <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 nderstand this is not a permit and work is not to start without a permit; and that the <br /> work will be in ac rdance �ith the approved plan. <br /> � ' 06/02/06 <br /> Applicant Date <br /> Reset Form �°��°0�°edpe�,;t3"S'°4, <br />