HomeMy WebLinkAbout2004-P07786 - land alteration PERMIT
CITY OF ORONO
`2750 Kelley Parkway - PO Box 66 Permit Number: Po��s6
Crystal Bay, Minnesota 55323 Permit Type: User Defined
(952) 24�-4600 Date Issued: s�3�2o04
SITE ADDRESS: 805 Forest Arms Ln
Mound,MN 55364
PID: 07-117-23-12-0009
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: User Defined Peimit Sub-type(s): Land Alteration(0-500 cu y�
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 50.00
Valuation: $ 0.00
TOTAL FEE: $ 50.00
APPUCANT: Owner/Self OWNER: Albert&Valerie Guralnik
� 805 Forest Arms Ln
Mound,MN 55364
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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A [CANT PERMITEE SIGNATURE SUED BY SIGNATURE
Copies: 1-File(Si�nitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
,��,�` City of Orono FOR CITY USE ONLY
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O= O P.O.Box 66 Date Received: �'3 'a`'l Permit#
a;,;r:.�,�,_ 3750 Kelley Parkway
L � � ,�'�Jj- F Crystal Bay,MN 55323 Amount: $ C.U.P Filed: NO
�'�'�r�+�1���� (952)249-4600
�KO� Approved By:�� Site Plan: t�P 5
Recommends: A roval Denial ❑
CITY OF ORONO - USER DEFINED/GENERAL PERMIT
(All pein�its must be approved by the Building Official and/or Zoning Department)
Job Site/Owner Infornlation:
Site Address: %� � � � �{%e, � �-�� ►�1��IS �G'L)'7L
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Owner: � t��� f � 1/�� � ��� Mailing Address: ��J �G�'�'� ��:���
City: �./�� i� J Zip: -�'�?h ��
Home Phone: �f Sn "( i',�`�� `'�y Alternate Phone: ���.,2 ?�� ;� `�:-��
Contractor/Applicant I�iformation:
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Contractor/App.: f C��,� ,�� Contact Person: �Gr�(c: ����-
Address: ��� 5� �S ,`� S�- 1�� State License #:
City: ✓��C����%���,Lr,r�Zip: S.� Expiration Date:
Phone: �>> 2 �yJ� 7C Y�G Alternate Phone:
TYPES OF USER DEFINED PERMITS
❑ Stairwav to Lake ❑ Retaining Walls ❑ Temporarv Trailer
General—User Defined Surcharge Generai—User Defined Surcharge General—User Defined
* (Per UBC) * (Per UBC) * $30.00
*Estimated Cost: $ *Estimated Cost: $
❑ Docks—42" or Greater � Land Alteration ❑ Zoning Review
General—User Defined Surcharge General—User Defined General—User Defined
❑ Commercial—(Per UBC) � 0-500 Cubic Yards *ForO-75'Zone-$30.00
* Estimated Cost: $ $5�.�� (Needs Site Plan)
General—User Defined ❑ 501+CubiC Y3rds
❑ Residential- $30.00 $50.00 (Needs C.u.�.)
❑ Tree Removal
General—User Defined
*Within 0-75' -$30.00
I herUy 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 the City and with the State
Building Code;that I understand this is not a pernlit and work is not to start without a permit;and that the work
will be in ccordance with the approved plan.
, ���/�
Applicant Date
(User DeCuied PemvY3/18/04)