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, CITY OF ORONO * 2 0 1 6 - 0 1 3 5 0 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/3U2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1885 CONCORDIA ST <br /> PIN : 17-117-23-23-0002 <br /> LEGAL DESC : COFFEES ADDN TO SHADY WOOD LAK <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ACCESSORY STRUCTURE <br /> PROPERTY TYPE : RESIDENTIAL <br /> COI�ISTRUCTION TYPE : POOL-IN GROUND <br /> ACTIVITY : 329-STRUCTURES OTHER THAN BUILDINGS <br /> VALUATION : $ 32,000.00 <br /> NOTE: SEPARA7'E PERMIT REQUIRED: MECHANICAL AND ELECTRICAL(STATE) <br /> IN-GROUND POOL <br /> APPLICANT PERMIT FEE SCHEDULE 512.70 <br /> STATE SURCHARGE(VALUATION) 16.00 <br /> PERFORMANCE POOL& SPA TOTAL 528.70 <br /> 2405 ANNAPOLIS Payment(s) <br /> PLYMOUTH,MN 55441- CHECK 1556 528.70 <br /> (763)270-1180 <br /> OWNER <br /> KAISER, BERNARD&CAROLYN <br /> 2855 PROVIDENCE PLACE <br /> INDEPENDENCE, MN 55359- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shali be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This permit is for only the work described and docs <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 /> shali be compied with whether or not specified hemin.This perniit wili <br /> expire and become null and void if construction authorized is not <br /> commenced within 1 RO days of lhe date of issuance,or if construction is <br /> suspended for a period of 180 days at any timc after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested i conformance with the State Building Code.This permit may be <br /> revoked t ny or due cause. <br /> G � 7�-� �� /L� l� � l�� <br /> Applicant Permitee Signat e Date �Issued Signature Date <br />