HomeMy WebLinkAboutPermit application --�
.�,O��� FOR CITY,USE ONLY
` Date Received. ' ;--�>� �,;,�> Permit# ������'����
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\��og/�/ Amount: $ C.U.PFiled:
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/� � � Approved By: Site Plan:
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Recommends: A roval ❑ Denial ❑
�.�� r UF ORONO - USER DEFINED/GENERAL PERMIT
(All permits must be approved by the Building Official and/or Zoning Department)
� Job Site/Owner Information: �
Site Address: ,�(� `�t� �� S' G c� f�� /�
Owner: ��d ;����,��-,��— Mailing Address: 5�--�"-`�—'
City: 1���.��� Zip: �.S' �`� 1
Home Phone: �--�� ���7�,�� �� Alternate Phone: �.S'� ��`���� �/
Contractor/Applicant Information:
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Contractor/App.: ;_���,-��_ Contact Person:
Address: State License #:
City: Zip: Expiration Date:
Phone: Alternate Phone:
TYPES OF USER DEFINED PERMITS
❑ �
Stairwav to Lake �� Retainin�Walls ❑ Temporary lrailer
General—User Defined Surcharge General—User Defined Surcharge General—User Defined
*(Per UBC) *(Per UBC) �.--� *$30.00
*Estimated Cost: $ *Estimated Cost: $�3,i�v �
❑ Docks—42"ar Greater � Land Alteration ❑ Zoning Review
General—User Defined Surcharge General—User Defined General—User Defined
❑ Commercial—(Per UBC) � 0-500 Cubic Yards *Far0-75'Zone-$30.00
*Estimated Cost: $ $5�.��(Needs Site Plan)
General—User Defined ❑ 501+CubiC Yards
❑ Residential- $30.00 $50.00(Needs C.U.P.)
❑ Tree Removal
General—User Defined
*Within 0-75' -$30.00
I herby apply for a User Defined Permit and I acknowledge that the information above is complete and
accurate;that the work will be in conformance with the Ordinances and Codes of tl�e City and with the State
Buildin Code� that I rsta d th' ' not a rt and work is not to start without a pennit; and that the
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work w�j��t c�ofdanc� . "� t�� ve"d plan.
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Applicant ' � ` Date
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