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. , CITY OF ORONO * Z 0 1 6 - PJ 0 9 1 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/19/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2760 COUNTRYS[DE DR W <br /> PIN : 04-117-23-12-0011 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 003 BLOCK 002 <br /> PERMIT TYPE : ADDITION/REMODEL/REPAIR <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ 25,000.00 <br /> NO"I'E: ADDITION <br /> SEPARATE PERMITS REQUIRED: ELECTR[CAL(STATE) <br /> NOTE: SEE BUILDERS ACKNOWLEGEMENT FORM <br /> APPLICAIYT PERMIT FEE SCHEDULE 433.67 <br /> STATE SURCHARGE(VALUATION) 12.50 <br /> STERN,JON& MOLLY TOTAL 446.17 <br /> 2760 COIJNTRYSIDE DR W Payment(s) <br /> LONG LAKE, MN 55356 CHECK 10596 446.17 <br /> OWNER <br /> STERN,JON&MOLLY <br /> 2760 COUNTRYSIDE DR W <br /> LONG LAKE,MN 55356 <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 /> State Building Code. 1'his permit is for only the work described and does <br /> not grant permission ror additional or relatcd 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 specified herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 1 AO days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time aRer 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 /> ������ <br /> Applicant Permitee Sig at e Date [ssued Signature Date <br />