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CITY OF ORONO PERMIT NO.: 2011-00942 <br /> ` 2750 KELLEY PARKWAY <br /> � ORONO, MN 55356- DATE Iss[1En: 08/26/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2587 KELLY AVE <br /> PIN : 20-117-23-14-0021 <br /> LEGAL DESC : TOWNSITE OF LANGDON PARK <br /> : LOT 004 BLOCK 005 <br /> PERMIT TYPE : ADDITIONAL STATE SURCHARGE <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADDITIONAL STATE SURCHARGE <br /> NOTE: THIS WAS AN ADDITIONAL STATE SURCHARGE THAT WAS COLLECTED DUE TO THE STATE SHUTDOWN IN 201 l. <br /> FOR PERMIT#:2011-00749 <br /> 1 SSU ED: 07/27/2011 <br /> APPLICANT <br /> STATE SURCHARGE FLAT-ADDITIONAL 4.50 <br /> DORAN ENTERPRISES INC. TOTAL 4.50 <br /> 1440 KELLY DRNE <br /> GOLDEN VALLEY, MN 55427 <br /> (763)546-5066 <br /> Minnesota State License#: 58224PM <br /> OWNER <br /> WARE,ALEXANDER <br /> 2587 KELLY AVE <br /> EXCELSIOR, MN 55331- <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 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[he 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 /> requcsted in conformance with the State Building Code.This permit may be <br /> revoked at any time for e use. <br /> , . J /,'k'►i <br /> �` <br /> - �'„�7 ;��// <br /> Appiicant Per itee S'gnature �Date � �" ���� ��' ��L��"� / / �� <br /> Issued By S�gnature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />