HomeMy WebLinkAbout2004-P07866 - land alteration �'�TY� F R N PERMIT
� � � � Permit Number:
2750 Kelley Parkway- PO Box 66 P07866
Crystal Bay, Minnesota 55323 Permit Type: uSerDef�ed
(952) 249-4600 Date Issued: 8/24/2004
SITE ADDRESS: 1435 ParkDr
Mound,MN 55364
PID: o�-ii�-23-a2-oo20
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Pernut Type: User Defined Pernut Sub-type(s): Land Alteration(0-500 cu yc
DETAILS:
Approved per resolurion#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 50.00
Valuation: $ 0.00
TOTAL FEE: $ 50.00
APPLICANT: Owner/self OWNER: James Martinson
M� 1435 Park Dr
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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APPLICANT PERMITEE SIGNATURE SUED BY SIGNATURE
Conies: 1-File(SiQnitures Re4uired), 1-Anplicant, 1-Monthlv Renorts, 1-AssessinQ, 1-Finance Page 1
a �0� City of Orono FOR CITY USE ONLY
0, 0 P.O.Box 66 Date Received: —Zy"o� Permit#
�i;,:,>.�,. 27�0 Kelley Parkway
a '�1''''���r'�� '� C s�al Ba ,MN 55323
,y �,y;,{,;;;�- �, rY Y Amoun[: $ C.U.P Filed:
`� �"�vi�;'���,� (952)249-4600 `' ,/ o
�"�saxo� APproved By: �%y��aSite Plan:�-2�- �
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2econunends: A roval,� Denial ❑
CITY OF ORONO - USER DEFINED/GENERAL PERIVIIT
(All pennits must Ue approved by tlie Building Official and/or Zonin�Department)
Job Site/Owner I�iforniation:
Site Address: ��,� S �Gt/�,� �,�� v <'
Owner: ��� /,'�d/�7`��S��� Mailing Address: �ssf� .//.��,�z��v�E:�� �i�.
City: �T t� ^ � 6� � Zip: �S >� � ��
Home Phone: f �� � � �- �6� �� � Alten7ate Phone: � ��' �� � ��" � Y� �
Conh-actor/Applicant I�iforniation: -� /��
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Coiztractor/App.: �� ��dt�� �'S� c� !?��� � �
Contact Person:
Address: State License #:
City: Zip: Expiration Date:
Phone: Alternate Phone:
TYPES OF USER DEFINED PERMITS
❑ Stairway to Lake ❑ Retainin�Walls ❑ Temporarv Trailer
General-User Defined Surcharge General-User Defined Surdiarge General-User Defined
*(Per UBC) * (Per UBC) * $30.00
*Estimated Cost: $ * Estimated Cost: $
❑ Docks—42" or Greater � Land Alteration A►01°��� ❑ Zoning Review
General-User Dzf ned Surcharge General-User Detined General-User Detined
❑ Conunercial—(Per UBC) ❑ 0-500 Cubic Yards *ForO-7S Zoue-$30.00
* Estimated Cost: $ �SSO.00 (Needs$ite Plan)
General-User Detined ❑ 501+Cubic YaTds
❑ Residential- �30.00 $50.00(Needs C.U.P.)
/� Tree Removal �� -
rw�-'�'
�� General-UserDefned �'^� �� SCP�''M-� �'�-
*Within 0-75' -$30.00 � �1�f _'�
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I herby apply for a User Defined Perniit and I aclmowledge 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 pezznit and work is not to start without a pemut;and that the work
will be in accordance with the approved plan.
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Ap 'cant Date
,
(User pofined Pecarit.3lt SlOa)