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CITY OF ORONO PERMIT NO.: 2010-00691 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 08/10/2010 <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1801 WEST FARM RD <br /> PIN : 27-118-23-44-0019 <br /> LEGAL DESC : N/A <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MINOR ALTERATIONS <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CHIMNEY-REPAIR <br /> ACTIVITY : 0/S BUILDING-UNDEFINED <br /> VALUATION : $ 10,000.00 <br /> NOTE: CHIMNEY-ROOFLINE UP REBUILD AND RELINE <br /> APPLICANT PERMIT FEE SCHEDULE 191.75 <br /> JACK PIXLEY SWEEPS INC. STATE SURCHARGE(VALUATION) 5.00 <br /> 4179 149TH AVE.NW <br /> ANDOVER,MN 55304 TOTAL 196.75 <br /> (763)422-0011 PAID WITH CC# 0171 <br /> Minnesota State License#: 20183369 <br /> OWNER <br /> PIERPONT,JAMES&JUDITH <br /> 1801 WEST FARM 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 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 permit may be <br /> revoked at any (ypjcaussyR� � i� <br /> G/J// <br /> , / 1a / )) /, ri /6)l /D <br /> Applicant Permitee Signature Date I :� BySignature Date <br /> g <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />