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CITY OF ORONO PERMIT NO.: 2011-00989 <br /> 2750 KELLEY PARKWAY <br /> �� ORONO, MN 55356- DATE ISSUED: 09/OU2011 <br /> ' 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2650 FOX ST <br /> PIN : 04-117-23-41-0003 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1249 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ADDIT[ONAL STATE SURCHARGE <br /> PROPERTY TYPE : RESIDENT[AL <br /> CONSTRUCTION TYPE : ADD[TIONAL STATE SURCHARGE <br /> NOTE: THIS WAS AN ADDITIONAL SIATE SURCHARGE THAT WAS COLLECTED DUE TO THE STATE SHUTDOWN IN 2011. <br /> FOR PERMIT#:201 1-001]0 <br /> ISSiJED:07/20/201 1 <br /> APPLICANT STATE SURCHARGE FLAT-ADDITIONAL 4.50 <br /> BURNS EXCAVATING, [NC. TOTAL 4.50 <br /> 3470 CO. RD 21 <br /> MAYER, MN 55360- <br /> (612)685-4303 <br /> Minnesota State License#: 1888 <br /> OWNER <br /> PAULSON, STEPHEN <br /> 2650 FOX ST <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> �I�he w�ork 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."I�his permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 1.80 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 inspec[ions are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. n '�� ,/�//� � � ,�� <br /> " `� <br /> ,�� ��1�-,�,{,� ���(.-� � -��_ �����e���� � �� � <br /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />