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CITY OF ORONO PERMIT NO.: 2009-00775 <br /> 2750 KELLEY P�RKWAY <br /> ORONO, MN 55356- DATE IssuEn: 1UO2/2009 <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> AllDRESS : 2189 SHADYWOOD RD <br /> PIN : 17-117-23-43-0137 <br /> LEGAL DESC : WILEYS PARK LAKE MTKA <br /> : LOT 008 BLOCK 002 <br /> PERMIT TYPE : MINOR ALTERAT[ONS <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ROOF[NG -ASPHALT <br /> ACTNITY : O/S BUILD[NG-UNDEFINED <br /> VALUATION : $ 3,200.00 <br /> APPLICANT PERMIT FEE SCHEDULE 103.25 <br /> INCLINE ENTERPRISES INC STATE SURCHARGE(VALUATION) 1.60 <br /> 26175 BIRCH BLUFF RD TOTAL 104.85 <br /> SHOREWOOD, MN 55331 <br /> (612)471-9065 <br /> Minnesota State License#: 20168831 <br /> OWNER <br /> LARSON,THOMAS <br /> 2189 SHADYWOOD RD <br /> WAYZATA, MN 55391 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvais,and the <br /> State Building Code. This permit is for only the work described and does <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specitied herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 days o he date of issuance,or if construction is <br /> suspended for a iod of 18 d ys at any time atter work has commenced. <br /> The applicant i sponsibl f assuring required inspections are <br /> requ ted in c ormance i the Sta[ ilding de.This permit may be <br /> revo ed at a time for ause. i f�-- Z _ /��; <br /> �� �-- � � `� � C���'� `- r <br /> �`-� i i <br /> ' nt rmrtee Sig t Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />