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CITY OF ORONO � z 0 1 7 - 0 0 0 z 0 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: OU24/2017 <br /> • ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2800 SHADYWOOD RD <br /> PIN : 21-117-23-13-0023 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1196 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : NEW STRUCTURE <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : S[NGLE FAMILY <br /> ACTIVITY : 101-SINGLE FAMILY HOUSES, DETACHED <br /> VALUATIOIY : $ 500,000.00 <br /> NOTE: SEPARATE PERMITS REQU[RED:PLUMI3ING,MECHAN[CAL,F[REPLACE,WATER CONNECTION,SEWER CONNECTION, <br /> ELECTR[CAL(STATE) <br /> NOTE:PLEASE SEE AND INITIAL NEW BUILDER ACKNOWLEDGEMENT FORM <br /> SAC WAS GRANDATHERED[N-SEWER&WATER HOOKUP DONE 50201972, PERMIT#3082,RECLAIM FROM DEMO CREDIT <br /> APPLICANT PERMIT FEE SCHEDULE 3,629.92 <br /> CREEK HILL CUSTOM HOMES STATE SURCHARGE(VALUATION) 250.00 <br /> 15235 65TH PL N TOTAL 3,879.92 <br /> MAPLE GROVE, MN 55311- Payment(s) <br /> (763)553-0325 CHECK 1219 3,879.92 <br /> Minnesota State License#: BUIL-20415174 <br /> OWNER <br /> BERGH, HANS& SHARON <br /> 2800 SHADYWOOD RD <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 /> 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 /> 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 nuli and void if construction authorized is not <br /> commenced within l80 days of the date of issuance,or if construction is <br /> suspended for a period of l80 days at any time after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for du •cause. <br /> � �. �� <br /> % ��y-1� ���� /����t� � ���� �� <br /> Applican ermi ee Signature Date Issue By Signature Date <br />