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e � <br /> CITY OF ORONO * z 0 1 4 - 0 1 0 3 0 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/16/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : �1250 FOREST LAKE DR <br /> PIN : 07-117-23-12-0022 <br /> LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN <br /> : LOT 000 BLOCK 002 <br /> PERMIT TYPE : MINOR ALTERATIONS <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE . $IDING� ° � <br /> �,�S �C�t cr ��Y"���,i� -�i{'�l C <br /> VALUATION : $ 24,997.0� <br /> NO�CI:: RI;SIDING HOMG. REMOVAL OF EXISTING <br /> APPLICANT PERM[T FEE SCHEDULE 413.00 <br /> STATE SURCHARGE(VALUATION) 12.50 <br /> THE HOME DEPOT A.H.S. MAIL-IN FEE 2.00 <br /> 2690 CUMBERLAND PKWY, STE 300 <br /> 30339- TOTAL 427.50 <br /> (763) 542-8826 Payment(s) <br /> Minnesota State License#: BUIL-20268257 CHECK 69148 427.50 <br /> OWNER <br /> ETAL, ROBERT DONGOSKE <br /> 4250 FOREST LAKE DR <br /> MOUND, MN 55364 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be perfonned 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 Cor additional or relaCed work which requires scparate <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 thc State Building Code.This permit may be <br /> revoked at am time for due causc. <br /> . ` <br /> C / / / d,1�V i� i � <br /> Applicant Permitee Signature� Date � Issu By Signature Date � <br />