e-Permitting - Cook County, Minnesota

Emergency Management Physical Address Replacement Application UID # 6775
App. Status: ApprovedMike Keyport
218-387-3059
mike.keyport@co.cook.mn.us

Property Owner Information:

Name:

Jean Skinner

Phone:

(218

) 218

- 2183

Email Address:

tom@lutsen.com

Mailing Address:

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
27-121-4450	67 EAGLE MTN LN		5	60	LUTSEN TWP	21	3		SKINNER JEAN D	SKINNER JEAN D

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

Charge	Cost	Quantity	Total
Non-Taxable
Physicsl Address Replacement Application Fees added 09/09/2022 1:12 PM $25.00	$25.00	x 1	$25.00
Subtotal			$25.00 0
Grand Total
Total			$25.00
Payment 09/09/2022			$25.00
Due			$0.00

Approval	Signature
Applicant	Tom Rider - 09/09/2022 1:12 PM 38ade579b0617261658fbb255f3c745a cfe3650970397790218d8d5e6990d581
#3 Sign Made	Mike Keyport - 09/13/2022 12:13 PM 4f7105d12896bf07c6a342a8b697987a 85966fae3d929f28aea1de2bc71c47ea

Application has been approved. All signatures have been obtained.