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CITY OF ORONO PERMIT NO.: 2011-01056 <br /> 2750 KELLEY PARKWAY <br /> ' ORONO,MN 55356- DATE ISSUED: 09/20/2011 <br /> ' 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 4680 NORTH ARM DR W <br /> PIN : 06-117-23-23-0006 <br /> LEGAL DESC : UNPLATTED 06 117 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ADDITION/REMODEL/REPAIR <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FOUNDATION ONLY <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ 3,300.00 <br /> NOTE: 6 ANCHORS-FOUNDATION REPAIR <br /> APPLICANT pERMIT FEE SCHEDULE 103.25 <br /> JESSE TREBIL FOUNDATION SYS INC. STATE SURCHARGE(VALUATION) 1.65 <br /> 60335 U S HWY 12 <br /> LITCHFIELD,MN 56387- MAIL-IN FEE 2.00 <br /> (320)9748729 TOTAL 106.90 <br /> Minnesota State License#:20446489 <br /> OWNER <br /> WESTFALL,MYRON&PATRICIA <br /> 4680 NORTH ARM DR W <br /> MOLJND,MN 55364 <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. This permit is for only the work described and dces <br /> not grant permission for additional or related work which requires sepazate <br /> permits. All provisions of laws and ordinances goveming this type of work ' <br /> shall be compied with whether or not specified herein.This pertnit 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for�ue cause. <br /> ��/�-�( � / / / / <br /> Applicant Permitee Signature Date Issued By i ature ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB . <br />