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CITY OF ORONO * 2 0 1 4 - 0 0 0 6 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 02/26/2014 <br /> . ORONO, MN 55356- <br /> . (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 258 CYGNET PL <br /> PIN : 04-117-23-23-0019 <br /> LEGAL DESC : SWAN LAKE ADDN <br /> : LOT 010 BLOCK 003 <br /> PERMIT TYPE : ADDITION/REMODEL/ RFPAIR <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADDN/ REMODEL/REPAIR <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ 6,400.00 <br /> NO"I�E: SEPARA�CF,PERMI"1'S RF,QUIRF,D: ELECTRICnL(STA7�E) <br /> BASEMLNT RL'MODEL <br /> ADV PLAN REVIEW 2014-00063 $95.88 <br /> APPLICANT PERMIT FEE SCHEDULE 147.50 <br /> STATE SURCF{ARGE(VALUATION) 3.20 <br /> DOUG LARSON CONSTRUCTION <br /> TOTAL 150.70 <br /> 16102 TEMPLE LANE <br /> MINNETONKA, MN 55345 Payment(s) <br /> �� CREDIT CARD 2064 1�0.70 <br /> Minnesota State License#: BUIL-BC06418 <br /> OWNER <br /> HUBBARD, ANNIE <br /> 258 CYGNET PL <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> I�he�vork ibr which this permit is issucd shall be performed according to <br /> the approvcd 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 Ihis type of�vork <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 I 80 davs of the datc of issuance,or if construction is <br /> suspended for a period of 180 days at any time alter�vork has commenced. <br /> I�he applicant is responsible for assurin�all required inspections are <br /> requested in conformance N�ith the State Building Code."l�his permit may bc <br /> revoke.d�at e�1y time for due cause. �- <br /> C�" ,,. <br /> � � �� ti� � � <br /> Ap icant Permitee Sig a re Date Issued I3y gnature � Date <br />