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� ,� CITY OF ORONO PERMIT NO.: 2011-00480 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 06/16/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 4455 FOREST LAKE LANDING <br /> PIN : 07-117-23-24-0037 <br /> LEGAL DESC : REG. LAND SURVEY NO. ]019 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MINOR ALTERATIONS <br /> PROPERTY TYPE : RESIDENT[AL <br /> CONSTRUCTION TYPE : ROOFING-ASPHALT <br /> ACTIVITY : O/S BUILDING - UNDEFINED <br /> VALUATION : $ 5,000.00 <br /> NOTE: TEAR OFF REROOF HOUSE <br /> APPLICANT PERM[T FEE SCHEDULE 118.00 <br /> MIDWEST ROOFING STATE SURCHARGE(VALUATION) 2.50 <br /> 6541 SYCAMORE CT N TOTAL 120.50 <br /> MAPLE GROVE, MN 55369- <br /> (763)427-9696 <br /> Minnesota State License#: 20637010 <br /> OWNER <br /> ERICKSON, SANFORD& MARGARET <br /> 4455 FOREST LAKE LANDING <br /> MOUND, MN 55364 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this pennit is issued shall be perfonned according to <br /> the approved plans and specitications,applicablc 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 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 180 days of the date of issuance,or if construction is <br /> suspended for a period of I 80 days at any timc after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> reques[ed in conformance with the State Building Code.This permit may be <br /> revokefl�Cany tim r due cause. - <br /> � (1� ��� � � � (p� l (�� /� <br /> Applicant Permitee Signature Date Issue y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />