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CITY OF ORONO * 2 PJ 1 4 - 0 1 P1 7 6 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/22/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 649 FERNDALE RD W <br /> PIN : 02-117-23-44-0003 <br /> LEGAL DESC : AUDITOR'S SUBD.NO. 184 <br /> : LOT 102 BLOCK 000 <br /> PERMIT TYPE : ADDITION /REMODEL/REPAIR <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ 98,851.95 <br /> NOTE: WATGR DAMAGI?-OK'D I3Y LY1,1; <br /> APPLICANT PERMIT FEE SCHEDULE 1,04925 <br /> GIERTSEN COMPANY STATE SURCHARGE(VALUATION) 49.43 <br /> 8385 l OTH AVE N TOTAL 1,098.68 <br /> GOLDEN VALLEY, MN 55427- Payment(s) <br /> (763) 546-1300 CREDIT CARD 3846 1,098.68 <br /> Minnesota State L.icense#: BUIL-BC 1796 <br /> OWNER <br /> ROBSON, PETER& ANN <br /> 649 FERNDALE RD W <br /> WAYZATA, MN 55391 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> Statc E3uilding 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."l�his 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 afte work has commenced. <br /> The applicant is responsible lor assuring all re � ed inspections are <br /> requested in confornr ce with the State B � ng Code.This pennit may be �/� <br /> revoked at any t� or due cause. � <br /> - ��'� --� ( ' ,?/( C f/r � -��Z Z� C <br /> Applic• ermitee Signature Date [ssued�ature � Date � <br />