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� � <br /> CITY OF ORONO * 2 0 1 2 — 0 0 7 6 6 * <br /> 2750 KELLEY PARKWAY DATE �SSUED: 09/19/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1095 FERNDALE RD W <br /> PIN : 02-117-23-43-0023 � <br /> LEGAL DESC : NORTH SHORE COTTAGE ACRES LAKE <br /> : LOT 009 BLOCK 000 <br /> PERMIT TYPE : DEMOLITION <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DEMO-PRINC[PAL STRUCTURE <br /> ACTIVITY : 645-S[NGLE FAMILY HOUSES(ATT& DET <br /> NOTE: <br /> l. FOUNDATIONS/ALL DEMO DEBR[S TO BE REMOVED FROM GROUND&DISPOSED OF OFF SITE,PER PCA REGULATIONS. <br /> 2. WELLS MUST BE ABANDONED. <br /> 3. INSPECTIONS DONE BEFORE BACKFILLING. <br /> NOTE: A 24-48 IiOUR NOTICE IS REQUIRED FOR ALL INSPECTIONS. CALL(952)249-4600. <br /> SEWER MUST BE DISCONTINUED AT THE CITY SERVICE C3Y QUALIFIED CONTRACTOR BEFORE DEMO PERMIT IS ISSUED. <br /> CHGCK TO MAKE SURE THIS PERMIT HAS BEEN PULLED 13EFORG ISSU[NG THIS PERMIT. <br /> APPLICANT DEMOLITION - PRINCIPAL STRUCTURE 75.00 <br /> BOHN WELL DRILLING CO. STATE SURCHARGE DEMO 5.00 <br /> 18190 DAIRY LANE <br /> JORDAN, MN 55352- DEMOLITION -ACCESSORY STRUCTURE 100.00 <br /> (952)445-4809 TOTAL 180.00 <br /> Minnesota State License#: 1043 <br /> OWNER <br /> FOX, B& K <br /> 1095 FERNDALE RD W <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> Thc work for which this permit is issued shall be performcd according to <br /> the approvcd plans and specitications,applicable City approvals,and the <br /> State 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. AII provisions oY laws and ordinances governing this type of work <br /> shall be compied with whcther 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 for assuring all required inspections are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> ��!tf.�.c.Q.i� �}l v74 / !a— �<�yy�t,r.�� �'l oZ� l i� <br /> Applicant Permitee Signature Date Iss d 13y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />