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e <br /> ' CITY OF ORONO PERm�T �vo.: 2010-olis� <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 12/2U2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2565 COUNTRYSIDE DR <br /> PlN : 04-117-23-11-OOlI <br /> LEGAL DESC : COUNTRYSIDE MANOR 2ND ADDN <br /> : LOT 001 BLOCK 003 <br /> PERMIT TYPE : MINOR ALTERATIONS <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DOORS <br /> ACTIVITY : O/S BUILDING - UNDEFINED <br /> VALUATION : $ 3,452.00 <br /> NOTG: RGPLACG(1)DOOR Wf"CIIIN EXIS7�ING OPLNINGS. <br /> APPLICANT PERMIT FEE SCHEDULE ]03.25 <br /> RENEWAL BY ANDERSON STATE SURCHARGE(VALUATION) 5.00 <br /> 1920 COUNTY RD C. WEST <br /> ROSEVILLE, MN 55113 MAIL-IN FEE 2.00 <br /> (612)502-4777 TOTAL 1 10.25 <br /> Minnesota State License#: 20130983 <br /> OWNER <br /> MICH, MR. c� MRS. <br /> 2565 COUNTRYSIDE DR <br /> LONG LAKE, MN 55356- <br /> AGREEMENT A[YD SWORN STATEMENT <br /> Thc�cork for���hich this pennit is issued shall be perfonncd according to <br /> thc approved plans and speci�ications,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 separalc <br /> permits. All provisions of laws and ordinances governing tl�is t��pe of�cork <br /> shall be compied�cith�cheU�er or not speeitied herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced���ithin 180 da��s of the date of issuance,or if construction is <br /> suspended for a period of I 80 days at any time alter���ork has commenced. <br /> The applicant is responsiblc for assuring all required inspections are <br /> requcsted in confonnance with the State Building Code.This permit may be <br /> revoked at any time for due.cause. <br /> ��1'1'Q�[� �' l l ��i�l't—��/� l l <br /> Applicant Permitee Signature Date Issued L3 � ignature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO <br />