HomeMy WebLinkAbout2011-00941 - add state surcharge CITY OF ORONO PERMIT NO.: 2011-00941
� 27�0 KELLEY PARKWAY
J ORONO, MN 55356- DATE IssUED: 08/26/2011
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2905 SIXTH AVE N
PIN : 28-118-23-31-0006
LEGAL DESC : GARDEN GROVE
: LOT 002 BLOCK 002
PERMIT TYPE : ADDITIONAL STATE SURCHARGE
PROPERTY TYPE : RESIDENTIAL
CONSTRiJCTION TYPE : ADDITIONAL STATE SURCHARGE
NOTE: THIS WAS AN ADDITIONAL STATE SURCHARGE THAT WAS COLLECTED DUE TO THE STATE SHUTDOWN IN 2011.
FOR PERMIT#:2011-00696
IS SUED:07/2 U2011
APPLICANT STATE SURCHARGE FLAT-ADDITIONAL 4.50
WRUCK EXCAVATING, INC.
15096 102ND ST TOTAL 4.50
BECKER,MN 55308
(320)267-1855
Minnesota State License#: 2714
OWNER
HAGEN&AGNETA TOTH,JEFFREY
2905 SIXTH AVE N
LONG LAKE,MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assurin�all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due caus . ,-
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Applicant Permitee Signatuie � Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
.
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o�°�o CITY OF ORONO MONTH: �u�y
P.O. BOX 66
�" ORONO, MN 55323
��o��'� (952)249-4600 fax(952)249-4616
DETAILS OF INVO/CE -
Customer
Name Doran Enterprises Inc. Date Created 7/28/2011
Address 1440 Kelly Drive
City Golden Valley State MN ZIP 55427
Rhor-�e
Qty Description Unit Price TOTAL
Due to the State Shutdown
1 Additional Charge for State Surcharge is Due $4.50 $4.50
Per Minnesota Statutes, Section 326B.148, Subdiv 1
For: Permit#2011-00749- Issued 07/27/2011 �
At: 2587 Kelly Ave
Sub Total $4.50
TOTAL DUE $4.50
Please return payment to City of Orono with a copy of this invoice included.
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