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r`-`�� Ci of Orono <br /> �4,���: tY FOR CITY USE ONLY <br /> O Q� P•O.Box 66 Date Received: Permit# <br /> '� ,:.. I`'� 2750 Kelley Parkway <br /> il.j, 1'. y' 1 Crystal Bay,MN 55323 <br /> \\7�'., `o��� (952)249-4600 Anwunt: � C.U.P Filed: <br /> �os <br /> 5�-tER25 63vss-(3 Na s�ft,co <br /> Approved By:�6• MtP6-F Site Plan: <br /> " cvo�x ��� a'/� P� `9,A.�-,,a,� <br /> Recommends: A roval Denial ❑ �� <br /> CITY OF ORONO- USER DEFINED/GENERAL PERMIT ��`"�'� ° <br /> ��F, <br /> (All permits must be approved by the Building Official and/or Zoning Depariment) � <br /> � <br /> ,�y�i <br /> Job Site/4wner Information: <br /> . <br /> SiteAddress: ��?J� I�►�)�T� I /�►� � ���v� <br /> Owner: _,� � ���1..��� Mailing Address: <br /> ���: r���n� Z�p: �s3�y <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> �,,�, . <br /> �ontractor/App.: �)�'�D� �Jf�1G�Y� 5����ontact Person: IYI D�-� �l�0�.�,o�elZ <br /> Address: S��b �I�1C bI In �1�I 1(� State License#: (��7�q���� <br /> Sv����25 <br /> City: ��1 �I'��- Zip:c��� Expiration Date: <br /> Phone: �I SZ'��'y��'�� Alternate Phone: �0�Z'�I LI�'�J�j��L- <br /> TYPES OF USER DEFINED PERMITS <br /> �Stairwav to Lake �3� ❑ Retainin�Walls ❑ Temporarv Trailer <br /> General—User Defined Surcharge Generat—User Defined Surcharge General—User Defined <br /> Rl..�����. *(Per UBC) *(Per UBC) *$30.00 <br /> ���� 1^A� *Estimated Cost:$��/� *Estimated Cost:$ <br /> S� ❑ Docks-42"or Greater �Lan lterat� n ❑ Zoning Review <br /> General—User Defined Surcharge General ser fined General—User Defined <br /> ❑ Commercial-(Per UBC) ,�'0-50 ubic Yards *ForO-75'Zone-$30.00 <br /> * Estimated Cost:$ SS .00 eeds Site Pian) <br /> Generat—Clser Defined ❑ 5 1+Cub� YSrds <br /> ❑ Residential- $30.00 $50.00(Nee .U.P.) <br /> � General—User Defined -- � <br /> -'�fiftii�i�-7�'�-� <br /> t 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 [ understand this is not a permit and wark is not to start without a permit; and that the <br /> work will be in accordance with the approved plan. <br /> �,��(�/�G� �� � � �� �b C� <br /> Applicant Dat� <br /> �vu.a�s�ea r.mn ansioa� <br />