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� CITY OF ORONO * 2 0 1 3 — 0 0 4 8 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/18/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADllRESS : 3515 SIXTH AVE N <br /> PIN : 29-118-23-43-0002 <br /> LEGAL DESC : UNPLATTED 29 1 18 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ADDITION/REMODEL/REPAIR <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ 80,000.00 <br /> NOTE: SEPF.RATE PF,RMITS REQUIRED: MECHANICAI,,ELECTRICAL(STATE) <br /> ADDITION <br /> ADV PLAN REVIEW COLLECTED ON PERMIT#2013-00482 <br /> APPLICANT PERMIT FEE SCHEDULE 906.75 <br /> MITTELSTAEDT INC STATE SURCHARGE(VALUATION) 40.00 <br /> 11730 BRADDOCK AVE SE <br /> P O BOX 454 TOTAL 946.75 <br /> WATERTOWN, MN 55388- PAID WITH CC# 8996 <br /> (6l2)716-9595 <br /> Minnesota State License#: 20012394 <br /> OWNER <br /> PETERSON, DALE& DIANE <br /> 3515 SIXTH AVE N <br /> LONG [,AKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMEIVT <br /> I�hc work tbr which[his permit is issued shall be performed according to <br /> the approved plans and specitications,applicable City approvals,and fhe <br /> State Building Code. This permit is Yor only the work described and does <br /> not gran[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 specified herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 1 SO days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time afrer work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoke t any time r due cause. <br /> �� � ,�ti� n 7 � 1� � �r3 ����__ � �� ;,�-��.s� � � �, ��';�� :�%--; <br /> Applicant Permitee Signature Date Issued By Signature � � Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />