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' � �� CITY OF ORONO * z 0 1 4 - 0 0 7 4 8 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 07/15/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1480 SIXTH AVE N <br /> PiN : 26-118-23-32-0008 <br /> LEGAL DESC : DOUGLAS ESTATES <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : ADDITION/REMODEL/REPAIK <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ 25,000.00 <br /> NOTE: SEPARATE PERMITS REQUIRED: I;I,F.C�I�RICAL(S�I�A"1�I?) <br /> INTF,R[OR BATHROOM RF,MODEL <br /> APPLICANT PERMIT �GE SCHEDULE 413.00 <br /> PLAN REVIEW 268.45 <br /> D.R. SIMON CONSTRUCTION LLC STATE SURCHARGE(VALUATION) 12.50 <br /> I5118 WILLISTON LANE TOTAL 693.95 <br /> MINNETONKA, MN 55343- <br /> (612)597-2386 Payment(s) <br /> Minnesota State License#: BUIL-BC004316 CREDIT CARD 0352 693.95 <br /> OWNER <br /> GULBRANDSON, DAN & ERICKA <br /> 1480 SIXTH AVE N <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issucd shall bc performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. 'I�his permit is for only the work described and docs <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 specitied 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 timc after work has commenced. <br /> "I�he applicant is responsible for assuring all required inspections are <br /> requested in conformance with the State Bui �ng Codc.This permit may be <br /> revoked at any time for due cause. �� <br /> ..-� + <br /> rr�t ' <br /> �iW�''. (��,/.' f "'' ,J <br /> �',{ ��_ L���.��..�'�.�-• l l <br /> p�y'cant Permitee Signature Date [ssued y Signature Date <br />