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{„ CITY OF ORONO * Z 0 1 6 - 0 1 PJ 9 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/27/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2166 SHADYWOOD RD <br /> PIN : 17-117-23-42-0011 <br /> LEGAL DESC : WILEYS PARK LAKE MTKA <br /> : LOT 000 BLOCK 001 <br /> PERMIT TYPE : ADDITION/REMODEL/REPAIR <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR <br /> ACTIV[TY : 434-RESIDENTIAL <br /> VALUATION : $ 78,000.00 <br /> NOTE: SEPARATE PERMITS REQUIRED: PLUMBING,MECHANICAL, ELECTRICAL(STATE) <br /> 1 ST FLOOR REMODEL <br /> APPLICANT PERMIT FEE SCHEDULE 936.56 <br /> STATE SURCHARGE(VALUATION) 39.00 <br /> REVISION LLC TOTAL 975.56 <br /> 153 E LAKE STREET <br /> WAYZATA,MN 55391- Payment(s) <br /> (952)540-7150 CHECK 12552 975.56 <br /> Minnesota State License#: BUIL-BC639027 <br /> OWNER <br /> LACROIX, STEPHEN&SUSAN <br /> 2166 SHADYWOOD RD <br /> WAYZATA,MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according[o <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 pennission 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 180 days at any time afrer work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in c ormance w the State Building Code.This permit may be <br /> revoked at y ti e for du use. � <br /> , f �_- <br /> �� <br /> , I C_: _ <br /> � /�—�-,C��E'-='1 ������ � / �'_l/ � �^ <br /> Applican P mitee Si ature Date Issued By Signature Date <br />