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CITY OF ORONO PERMIT NO.: 2009-00228 <br /> 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE ISSUED: 05/14/2009 <br /> (952) 249-4600 FAX: (952)249-4616 <br /> ADDRESS : 4505 WEST BRANCH RD <br /> PIN : 07-117-23-21-0014 <br /> LEGAL DESC : GARY LINDGREN ADDN <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : MINOR ALTERATIONS <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ROOFING-ASPHALT <br /> ACTIVITY : 0/S BUILDING-UNDEFINED <br /> VALUATION : $ 8,000.00 <br /> NOTE: REROOF TEAR OFF <br /> APPLICANT PERMIT FEE SCHEDULE 162.25 <br /> STEVEN MARVIN COYLE STATE SURCHARGE(VALUATION) 4.00 <br /> 12995 138TH STREET <br /> NORWOOD YOUNG AMERICA,MN 55368 TOTAL 166.25 <br /> (952)467-2612 PAID WITH CC# 6804 <br /> Minnesota State License#:20633103 <br /> OWNER <br /> LEVY,DAVID <br /> 4505 WEST BRANCH RD <br /> MOUND,MN 55364 <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 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 are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> i1 2 <br /> Applicant Permitee Signature /Date / i / ff/// /C/ <br /> Iss i7 By ignature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />