HomeMy WebLinkAbout2009-00481-VOIDED O¢0 A,O City of Orono FOR CITY USE ONLY
`r P.O.Box 66 Date Received: � Permit#qf��� �
2750 Kelley P
a "- ,C Crystal Bay,MN 5323
�r�'��o'yo' (952)249-4 00 Amount: $ C.U.P Filed:
Approved By: Site Plan:
�� Recommends: A rovai ❑ Denial ❑
CIT F NO-USER DEFINED/GENERAL PERMIT
cmits must be approved by the Building Official and/or Zoning Department)
Job Sit Owner Information:
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Owner: ,��`'� `'C ��' �r �•_� /L4,��� Mailing Address:
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City: Zip:
Home Phone: �-� � 7 " z'�= -l��' �� � Alternate Phone:
Contractor/Applicant lnformation:
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Contractor/App.: '� « (—��.��� �C--� ;<<- Contact Person: _�= i�✓? �`��`�
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Address: � �UC� �1�: ��� �f � State License#: L.G�C�������
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City; �f� ��w��� Zip: �`�G%r L Expiration Date: `�'
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Phone: � � -� - - �- ` � �`! �-- Alternate Phone: (-�5�- �.�f- `��c�/
TYPES OF USER DEFINED PERMITS
❑ Stairwa,y to Lake �Retaining Walls � Temporarv Trailer
General—User Defined Surcharge General—User Defined Surcharge Genera]—User Detined
*(Per UBC) *(Per UBC) *$30.00
*Estimated Cost:$ * Estimated Cost:$ ��' ��•"�'
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❑ DoCks-One Time(Non-Lake Mcka� ❑ Land Alteration ❑ Zoning Review
General—User Detined Surcharge General—User Detined General—User DeYined
❑ Commercial-(Per UBC) 8 0-500 Cubic Yards *ForO-75'Zone-$30.00
* Estimated Cost: $ $50.00(Needs sice Pian>
General—User Detined � 501+CUbIC YatdS
❑ Residential- $30.00 $50.00(Needs C.U.r.) � 1�; ��/,' ����� 54.,�J �`,,�
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� Tree Removal / "� (�
General—User Defined �`(�� "� y�S'' ` �
�` Within 0-75' -$30.00 C
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 the City and with the State
Building Code;that I understand this is not a permit and work is not to start without a permit; and that the
work will be in accordance with the approved plan.
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Applicant �-%� D te
Reset Form (Usu Dafined Petmit OS/O8/09)