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� R <br /> CITY OF ORONO PERMIT NO.: 2011-00535 <br /> 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE ISSUED: 06/28/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1930 SHADYWOOD RD <br /> PIN : 17-117-23-24-0022 <br /> LEGAL DESC : SHADY-WOOD <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MINOR ALTERATIONS <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ROOFING-ASPHALT <br /> ACTIVITY : O/S BUILDING-UNDEFINED <br /> VALUATION : $ 9,352.42 <br /> APPLICANT pERMIT FEE SCHEDULE 191.75 <br /> SIMON CONSTRUCTION STATE SURCHARGE(VALUATION) 4.68 <br /> 12366 RIVER RIDGE ROAD TOTAL 196.43 <br /> BURNSVILLE,MN 55337- <br /> (612)861-7000 PAID WITH CC# 3038 <br /> Minnesota State License#:20593656 <br /> OWNER <br /> ELMQUIST,DAVID A ' <br /> 1930 SHADYWOOD RD <br /> WAYZATA,MN 55391 <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 does <br /> not grant permission for additional or related work which requires separate <br /> permiu. All provisions of laws and ordinances goveming 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 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 /> revoke at any time for due c use. <br /> � �� ��� �/ l lJl <br /> Applicant Permitee Signature Date Issue y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OT ER THAN DESCRIBED ABOVE. <br />