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� CITY OF ORONO * 2 0 1 5 — 0 1 2 7 4 * <br /> 2750 KELLEY PARKWAY DATE [SSUED: 10/07/2015 <br /> ORONO, MN 55356— <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1629 BOHNS POINT RD <br /> PIN : 17-117-23-11-0005 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0565 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ADDITION/REMODEL/REPAIR <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ 15,000.00 <br /> NOTE: SEPARATE PERMITS REQUIRED: MECHANICAL,ELECTRICAL(STATE) <br /> INTERIOR STRUCTURAL CHANGES ONLY <br /> APPLICANT PERMIT FEE SCHEDULE 278.81 <br /> PLAN REVIEW 181.23 <br /> MATTSON SCHOSTER LLC STATE SURCHARGE(VALUATION) 7.50 <br /> 332 2ND STREET <br /> EXCELSIOR,MN 55331- TOTAL 467.54 <br /> (612)751-0488 Payment(s) <br /> Minnesota State License#: BUIL-BC663107 CHECK 2711 467.54 <br /> OWNER <br /> AMPLATZ,CAROLINE <br /> 345 LEAF ST <br /> WAYZATA, MN 55391- <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 goveming 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 ace <br /> requested in confo ance with the State Building Code.This permit may be <br /> revoked at an ti for due c se. <br /> `��� D <br /> �—t:c�-� l � 7 � t_S <br /> App rmitee Signature Date [ssued B ignature Date <br /> I� <br />