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, ��` City of Orono FOR CITY USE ONLY <br /> v O¢ `YO P.O.Box 66 Date Received://— � Permit# A�� ��� <br /> " 2750 Kelle Parkwa <br /> ���.� . Y y � � �� ��,,�d � <br /> � �j��,iF, F Crystal Bay,MN�5323 Amount: $ CU.P F.i�led: <br /> � �'�?p�r,��y�` (9S2)249-4600 L � � � � � <br /> �BKOg Approved By: /7i/ Site Plan: �" <br /> S� Recommends: A roval � Denial ❑ <br /> � C�7� Q7 "��33 <br /> � <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> � (All pennits must be approved Uy the Building Official and/or Zoning Department) <br /> � Job Site/Owner I�iforniation: <br /> � <br /> � / /�i�� <br /> Site Address: <br /> uf/� G{/� �rsPc <br /> Owner: �� �' /� u" �10 Mailing Address: ��V�I��L���1��f�I�� <br /> � c�ty: �'��_ls�� z�p: ,.�� �3 � <br /> � . . <br /> � Home Phone. Alternate Phone. <br /> � <br /> Conhactor/Applicant Information: <br /> �/ / f ,� / <br /> Contractor/App.: UL 9� 1.C� f�ClYy�� Contact Person: -�.JC�`'l� �/G��S%YO'!� <br />� <br />'� Address: ���� ���'O �f. � State License#: 2�� , �(� �O <br /> C� <br /> � City: � � Zip: �.��� Expiration Date: <br /> � Phone: CDI7_ ' �S � ` _/�5� Alternate Phone: ��Z. "�� - ��C�� <br /> � TYPES OF USER DEFINED PERMITS <br /> � cuR�� Rl` � <br /> � ❑ Stairwav t�Lake [�� � ❑ Tempora�y Trailer <br /> � General—User Defined Surcharge General—User Defined Surcharge General—User Defined <br /> * (Per UBC) * (Per UBC) v� * �30.00 <br />� *Estimated Cost: $ *Estimated Cost: $37�• <br /> � ❑ Docks—42"or Greater ❑ Land Alteration ❑ Zonin�Review <br /> � General—User Defined Surcharge General—liser Defined General—User Defined <br /> C� ❑ Commercial—(Per UBC) ❑ 0-500 Cubic Yards *ForO-7SZone-�30.00 <br /> *Estimated Cost: � $50.00 (Needs Site Plan) <br /> General—User Defined ❑ 501+Cubic Yards <br /> � ❑ Residential- �30.00 $50.00 (Needs C.u.P.) <br /> \� ❑ Tree Removal ��GY/C �`I�e� � ����� ��'� ��� <br /> � General—User Defined � <br /> -� *Within 0-75' - $30.00 <br /> ��j <br /> � w I herby apply for a User Defined Permit and I acknowledae that the infonnation aUove 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 pernlit and work is not to start without a pennit;and that the work <br /> will be in accordance with the approved plan. <br /> Applicant Date <br /> ir i�,.,n.F.,P,�n..,.,;�in aina� <br />