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� � L�I�l�lllll <br /> . CITY OF ORONO * Z 0 1 6 - PJ 1 3 2 5 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/2U2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2171 SHADYWOOD RD <br /> PIN : 17-117-23-42-0022 <br /> LEGAL DESC : BRENTEN WOODS <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : M1NOR ALTERATIONS <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WINDOWS <br /> ACTIVITY : O/S BUILDING-LJNDEFINED <br /> VALUATION : $ 7,827.00 <br /> NOTE: REPLACE(4)WINDOWS AND(1)DOOR <br /> APPL[CANT PERMIT FEE SCHEDULE 170.34 <br /> STATE SURCHARGE(VALUATION) 391 <br /> PELLA NORTHLAND MAIL-IN FEE 2.00 <br /> 15300 25TH AVE N. -SUITE# 100 <br /> PLYMOUTH,MN 55447- TOTAL 176.25 <br /> (952)345-6047 Payment(s) <br /> Minnesota State License#:BUIL-BC645090 CHECK 76273 176.25 <br /> OWNER <br /> ROBERTSON,JACQUELYN <br /> 2171 SHADYWOOD RD <br /> WAYZATA,MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according ro <br /> the approved pians and specifications,applicable City approvals,and the <br /> State Building Code. This permit is for only the work described and docs <br /> not grant pennission for additional or related w�ork�vhich requires separate <br /> permits. All provisions of laws and ordinances governing Ihis type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of l SO days at any time afte�work has commenced. <br /> The appiicant is responsible for assuring all required inspections are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> � <br /> /� l.ZG l/;(o <br /> Applicant Permitee Signature Date [ssued B ignature Date <br />