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4 , 1 <br /> CITY OF ORONO PERMIT NO.: 2008-00379 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 11112/2008 <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4701 WEST BRANCH RD <br /> PIN : 07-117-23-22-0016 <br /> LEGAL DESC : WEST BRANCH ACRES <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : DEMOLITION <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DEMO-PRINCIPAL STRUCTURE <br /> ACTIVITY : 645-SINGLE FAMILY HOUSES(ATT&DET <br /> NOTE: <br /> 1. FOUNDATIONS/ALL DEMO DEBRIS TO BE REMOVED FROM GROUND&DISPOSED OF OFF SITE,PER PCA REGULATIONS. <br /> 2. WELLS MUST BE ABANDONED. <br /> 3. INSPECTIONS DONE BEFORE BACKFILLING. <br /> APPLICANT DEMOLITION-PRINCIPAL STRUCTURE 50.00 <br /> ALBERTSON, DAVID&WENDI STATE SURCHARGE DEMO 0.50 <br /> 4701 WEST BRANCH RD TOTAL 50.50 <br /> MOUND,MN 55364 <br /> OWNER <br /> ALBERTSON,DAVID&WENDI <br /> 4701 WEST BRANCH RD <br /> MOUND,MN 55364 <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 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 /> reques in conformance with the State Build'.: '.4e.This permit may be <br /> revok d t any time .4 due <br /> ilia" <br /> II , 1000 <br /> Ap c ' mi. • Signature Date Iss,'d By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />