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'� CITY OF ORONO <br /> � * Z fd 1 4 — 0 1 2 1 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/20/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADllItESS : 4175 FOREST LAKG DR <br /> PIN : 07-117-23-1]-0006 <br /> LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN <br /> : LO"I' 007 BLOCK 003 <br /> PERMIT TYPE : MINOR ALTERATIONS <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : SIDING <br /> ACTIVITY : O/S BUILDING - UNDEF[NED <br /> VALUATION : $ 1,900.00 <br /> NO"I'E: SIDING <br /> APPLICANT PEIZMIT FEE SCHEDULE 70.50 <br /> STATE SURCHARGE(VALUATION) 0.95 <br /> TORKELSON, TIM TOTAL 71.45 <br /> 4175 FOREST LAKE DR Payment(s) <br /> MOUND, MN 55364- CREDI"T CARD 7061 71.45 <br /> OWNF,R <br /> TORKELSON,TIM <br /> 4175 FOREST LAKE DR <br /> MOUND, MN 55364- <br /> AGREEMEIYT AIVD SWORN STATEMENT <br /> I�he work Yor���hich this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State E3uilding Code. This permit is for only the work described and does <br /> not grant permission for additional or related work which requires separate <br /> permi[s. All provisions of laH�s and ordinances governing this type of work <br /> shall be compicd with whether or not specified herein.This permit will <br /> espire and become null and void if construction authorized is not <br /> commenced w�ithin 180 days of the date of issuance,or if construction is <br /> suspended for a period of l80 days at any[ime after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conf��rmance with the State F3uilding Coda This pennit may be <br /> revoked at any time for due cause. <br /> , <br /> ,_/��� /�, ' . <br /> yC/' �`� /.�`%t�c-C�''�c � ���' ' _.1 G- /� �" (� l� l� <br /> A'pplicant Permitee Signature Date Issued � Signature Date <br />