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CITY OF ORONO * 2 0 1 6 - PJ 0 4 8 � * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OS/OS/2016 <br /> � ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 128 CHEVY CHASE DR <br /> PIN : 36-118-23-41-0041 <br /> LEGAL DESC : H1LL O'WAY MANOR <br /> : LOT 007 BLOCK 002 <br /> PERMIT TYPE : MINOR ALTERATIONS <br /> PROPERTY TYPE . RE�S�D�NTIAL <br /> �•--� r� r-/ [a t ci �° <br /> COI�ISTRUCTION TYPE : SIDING / <br /> VALUATION : $ 5,000.00 <br /> APPLICANT PERMIT FEE SCHEDULE 123.87 <br /> STATE SURCHARGE(VALUATION) 2.50 <br /> BALANCING ROCK DESIGN TOTAL 126.37 <br /> 3277 190TH ST E Payment(s) <br /> PRIOR LAKE, MN 55372- CREDIT CARD 7060 12637 <br /> (952)484-6561 <br /> Minnesota State License#:GENR-20543820 <br /> OWNER <br /> NELSON,TODD&JANA <br /> 128 CHEVY CHASE DR <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 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 afrer 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 an time for due cause. <br /> � <br /> S _S I� � ��� f ,����U �i i 1 0 <br /> =Applicant Permi ignat re D te Issued By Signature Date <br />