e-Permitting - Cook County, Minnesota

Emergency Management Physical Address Replacement Application UID # 6163
App. Status: Pending ReviewMike Keyport
218-387-3059
mike.keyport@co.cook.mn.us

Applicant & Property Information

Property Owner Information:

Name:

Matt & Cathy McLane

Phone:

(612

) 964

- 5933

Email Address:

mclanecathy@gmail.com

Mailing Address:

13590 70th Ave N

Maple Grove	MN	55311

Property Information:

Parcel and Address				Section Township Range				Lake	Owner Information	Tax Payer Information
Parcel Number	Property Address	City	Deeded Acres	Township Number	Township or City	Section	Range	Lake Name	Owner Name	Taxpayer Name
27-127-4350	30 CHAGA LN		9	60	LUTSEN TWP	27	3		MC LANE MATTHEW D REVOC TRUST	MC LANE MATTHEW D REVOC TRUST

Terms

Terms and Conditions

I hereby certify with my signature that all data on my application forms, plans, are true and correct to the best of my knowledge

Invoice #5490 (04/30/2022)

Charge	Cost	Quantity	Total
Non-Taxable
Physicsl Address Replacement Application Fees added 04/30/2022 3:12 PM $25.00	$25.00	x 1	$25.00
Subtotal			$25.00 0
Grand Total
Total			$25.00
Payment 04/30/2022			$25.00
Due			$0.00

Invoice #5504 (05/03/2022)

Charge	Cost	Quantity	Total
Non-Taxable
Physicsl Address Replacement Application Fees added 05/03/2022 10:25 AM $25.00	$75.00	x 1	$75.00
Subtotal			$75.00 0
Grand Total
Total			$75.00
Due			$75.00

Approvals

Approval	Signature
Applicant	Cathy McLane - 04/30/2022 3:14 PM 504e72fd38e26025e1a168909683cd86 e04059a52fdfe073e0a74bbf5a1532c5
#3 Sign Made

Application will be approved after the above signatures are obtained.