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. •. <br /> CITY OF ORONO * 2 PJ 1 4 - 0 0 7 8 3 * <br /> 27_50 KELLEY PARKWAY DATE ISSUED: 07/29/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 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 TYPF. : ADDN/REMODEL/REPAIR <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ 35,000.00 <br /> NO"I�E: SEPARATE PF,RMITS RFQUIRED: ELF,CTRICAi,(S"I'ATE) <br /> � '� <br /> NOTE: PRIOR TO RELEASE OF F,SCROW,AN AS-I3UILT SURVh'Y MUS"1'BE SUBMITTED&APPROVED. tNIT1Al,: �� '� <br /> NO'CE: CONTnCT TFIE WATLRSHF.,D DISTRIC�I�TO DETERMINE IF ANY PGRMITS ARE RI:QUIRGD. INITIAL: � <br /> APPLICANT PERMIT FEE SCHEDULE 520.50 <br /> STATE SURCHARGE(VALUATION) 17.50 <br /> MITTELSTAEDT INC TOTAL 538.00 <br /> I 1730 BRADDOCK AVE SE Payment(s) <br /> P O BOX 454 <br /> WATER"I'OWN, MN 55388- CHECK 1749 538.00 <br /> (612)716-9595 <br /> Minnesota State License#: BUIL-20012394 <br /> OWNER <br /> PETERSON, DALE& DIANE <br /> 3515 SIX"I'H AVE N <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> fhe work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,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 ot'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 180 days at any time after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with the State Building Code.This pennit may be <br /> revoked at any time for due cause. <br /> � <br /> �.,�1 � <br /> � ��-� � l ��� �`� 7 ,��1 �/ <br /> Applicant Permitee Signature Dale Issue Signature Date <br />