e-Permitting - Cook County, Minnesota

Emergency Management Physical Address Replacement Application UID # 8062
App. Status: Pending ReviewMike Keyport
218-387-3059
mike.keyport@co.cook.mn.us

Applicant & Property Information

Property Owner Information:

Name:

Brian Martinson

Phone:

(607

) 280

- 7999

Email Address:

brian@brulelakecamp.site

Mailing Address:

5226 Saratoga Ln

ARLINGTON	TX	76017

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
27-347-0106	346 CAPS TRL		2.41	62	LUTSEN TWP	27	3		MARTINSON BRIAN	MARTINSON BRIAN

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 #7154 (08/04/2023)

Charge	Cost	Quantity	Total
Non-Taxable
Physicsl Address Replacement Application Fees added 08/04/2023 9:56 AM $25.00	$25.00	x 1	$25.00
Subtotal			$25.00 0
Grand Total
Total			$25.00
Payment 08/04/2023			$25.00
Due			$0.00

Approvals

Approval	Signature
Applicant	Brian Martinson - 08/04/2023 9:57 AM 31b7ebc991fc34e093a487b89943c095 85ea3763c57a13d56421894101c62d71
#3 Sign Made

Application will be approved after the above signatures are obtained.