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3 � CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 3 - 0 0 4 5 z * <br /> DATE ISSUED: 06/1 U2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2435 COUNTRYSIDE DR <br /> PIN : 04-117-23-11-0005 <br /> LEGAL DESC : COUNTRYSIDE MANOR <br /> : LOT 001 BLOCK 002 <br /> PERMIT TYPE : ADDITION/REMODEL/REPAIR <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ 55,000.00 <br /> NO"TE: SEPERA7'E PERMITS RF',QUIRED: PLUMI3ING, MECHANICAL, ELEC`IRICAL(S"1'A'I'F:) <br /> INI�ERIOR REMODEI, <br /> APPLICANT PERMIT FEE SCHEDULE 719.25 <br /> LEMMERMAN CONST. INC. PLAN REVIEW 467.51 <br /> 9037 CTY. RD 17 SE <br /> DELANO, MN 55328 STATE SURCHARGE(VALUATION) 27.50 <br /> (763)972-3003 TOTAL 1,214.26 <br /> Minnesota State License#: 4854 <br /> OWNER <br /> FULLERTON&ANDRIA MOLDZIO, JOHN <br /> 2435 COUNTRYSIDE DR <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which[his 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 rela[ed work which requires separate <br /> permi[s. All provisions of laws and ordinances governing[his 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 Yor assuring all required inspections are <br /> reques[ed in conformance wit t�ie State Building Code."I'his permit may be <br /> revoke at any time for du cau . <br /> --�-�-�-��- �l l /� � U��--� �� �� � l 5 <br /> A pli ant Permitee Si qature Date Is, ed By Signature Date <br /> I <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />