2011-00941 - add state surcharge

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CITY OF ORONO PERMIT NO.: 2011-00941 � 27�0 KELLEY PARKWAY J ORONO, MN 55356- DATE IssUED: 08/26/2011 (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2905 SIXTH AVE N PIN : 28-118-23-31-0006 LEGAL DESC : GARDEN GROVE : LOT 002 BLOCK 002 PERMIT TYPE : ADDITIONAL STATE SURCHARGE PROPERTY TYPE : RESIDENTIAL CONSTRiJCTION TYPE : ADDITIONAL STATE SURCHARGE NOTE: THIS WAS AN ADDITIONAL STATE SURCHARGE THAT WAS COLLECTED DUE TO THE STATE SHUTDOWN IN 2011. FOR PERMIT#:2011-00696 IS SUED:07/2 U2011 APPLICANT STATE SURCHARGE FLAT-ADDITIONAL 4.50 WRUCK EXCAVATING, INC. 15096 102ND ST TOTAL 4.50 BECKER,MN 55308 (320)267-1855 Minnesota State License#: 2714 OWNER HAGEN&AGNETA TOTH,JEFFREY 2905 SIXTH AVE N LONG LAKE,MN 55356- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assurin�all required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due caus . ,- ' /�'-/"' �"�:-� � -i( �.(�`/� � � ��-�f�-� � c�.c.�.n � � �: Applicant Permitee Signatuie � Date Issued By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.