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CITY OF ORONO PERMIT NO.: 2011-00824 <br /> -, 2750 KELLEY PARKWAY <br /> . ORONO, MN 55356- DATE ISSUED: 08/09/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3]5 HOLLANDER RD <br /> PIN : 25-118-23-43-0014 <br /> LEGAL DESC : HOLLY ACRES <br /> : LOT 001 BLOCK 002 <br /> PERMIT TYPE : ADDITIONAL STATE SURCHARGE <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADDITIONAL STATE SURCHARGE <br /> NOTE: "1'f lIS WAS AN ADDITIONAL STATE SURCHARGE THA"C WAS COLLECTED DUE TO THE STATE SHUTDOWN IN 2011. <br /> FOR PERMIT#:2011-00743 <br /> ISSUED:07/27/2011 <br /> City of Uror�o <br /> ��a Kelley ParkNay <br /> Qranu M�1 55355 952-24�-46C�v <br /> Receipt Na: 3.G05173 Rug 9, 2011 <br /> Ladahl Ir�. <br /> Previous Balance: •�� <br /> PerAits <br /> �ditional 5tate �•� <br /> Surcharge 2011-�1743 3l5 <br /> Hoilander Rd <br /> 1(�1-�G802 <br /> Due to gavts-5tate <br /> ---------4.5C� <br /> T��t al: <br /> �dew Balance: 4.�'�- <br /> APPLICANT Check M <br /> LODAHL INC. Check No: 27403 4,5fj 4.50 <br /> 667 WARNER AVE S �ayor: 4.50 <br /> MAHTOMED[, MN 55115 �"��1 I�� 4.5� <br /> (651)470-9946 Total Applied: '__��_______ <br /> Minnesota State License#: BC 2043408 Char�ge Tendered: +_____�_ �{�_ <br /> 08/0'�/2{}11 03:OfiPl1 <br /> OWNER <br /> FAGRE,NATHAN&CONSTANCE <br /> 315 HOLLANDER RD <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 Codc. This permit is for only the work described and does <br /> not gran[permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall bc 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 any time for due cause. , �1 <br /> /�� � <br /> l l `�� � (. ' � �� 1 / ��l��`��� <br /> Applicant Permitee Signature Date Issued By ignature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCR[BED ABOVE. <br />