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„ CITY OF ORONO * z 0 1 2 - 0 1 1 z 7 � <br /> , 2750 KELLEY PARKWAY DATE ISSUED: 1U19/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2735 COUNTRYSIDE DR W <br /> PIN : 04-117-23-12-0018 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 003 BLOCK 003 <br /> PERMIT TYPE : ADD[TION/REMODEL/ REPAIR <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ I5,000.00 <br /> NOTE: SEPGRA'I'E PERMI"I�S REQUIRED: PLUMBING, MECHANICAL, GLECTRICAL(S"I�ATI?) <br /> KITCHL'N RGMODEL <br /> APPLICANT PERMIT FEE SCHEDULE 265.50 <br /> JEFF HARRISON PLAN REVIEW 172.58 <br /> 2984 WATERTOWER PLACE <br /> CHANHASSEN, MN 55317- STATE SURCHARGE(VALUATION) 7.50 <br /> (612)919-7984 TOTAL 445.58 <br /> Minnesota State License#:20022883 <br /> OWNER <br /> ALEXANDER, TIM <br /> 2735 COUNTRYSIDE DR W <br /> LONG LAKE, MN 55356 <br /> AGREEMEIVT AIYD SWORN STATEMENT <br /> The work for���hich this permit is issued shall be performed according to <br /> the approvcd plans and specificat�ons,applicable City approvals,and the <br /> State[3uilding Code. This permit is for only the work described and does <br /> not grant permission for addilional or related work which requires separate <br /> permits. All provisions of la��s and ordinances governing this type of work <br /> shall be compied with whether or not speciticd herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commeneed within I 80 days oC 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 applican[is responsible for assuring all required inspections are <br /> requested in conformance with the State Building Code.This pennit may be <br /> revol�ed at any time tor due cause. <br /> 7 <br /> ' �_"__ �✓� /9 � / / <br /> Applica itee Signature Date <br /> Issue 3v S� nature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRBED AB E. <br />