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CITY OF ORONO * 2 B 1 2 — 0 0 6 QJ 9 * <br /> � L 2750 KELLEY PARKWAY DATE ISSUED: 06/28/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2990 SUSSEX RD <br /> PIN : 04-117-23-31-0020 <br /> LEGAL DESC : FOX BEND <br /> : LOT 3 BLOCK 4 <br /> PERMIT TYPE : ADDITION/REMODEL/REPAIR <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR <br /> ACTIVITY : 434-RES[DENTIAL <br />' VALUATION : $ 275,000.00 <br /> NOTE: SEPERATE PERMITS REQUIRED: PLUMBING,MECHANICAL,ELECTRICAL(STATE) <br /> APPLICANT PERMIT FEE SCHEDULE 2,106.75 <br /> WILLIAM POHLEN STATE SURCHARGE(VALUAT[ON) 137.50 <br /> 15623 NORMANDY LANE TOTAL 2,244.25 <br /> MINNETONKA, MN 55345- <br /> (612)396-6728 PAID WITH CC# 4038 <br /> Minnesota State License#: 20267452 <br /> OWNER <br /> KELLY,JUSTIN& SUSAN <br /> 2990 SUSSEX RD <br /> LONG LAKE, MN 55356- <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 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 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 of[he date of issuance,or if construction is <br /> suspended for a penod of 180 days at any[ime atter 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 /> revoked at any time for due cause. <br /> ._ ��Y_/ <br /> 1����f�l � ��� ���� - �.��--�–�� ���"�"�L` c � / / <br /> Applicant ermitee Si ure Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />