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w t <br /> CITY OF ORONO PERMIT NO.: 2009-00541 <br /> 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE ISSUED: 08/3U2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1795 SHADYWOOD RD <br /> PIN : 17-117-23-21-0008 <br /> LEGAL DESC : REG. LAND SURVEY NO.0702 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ADDITION/REMODEL/REPAIR <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CHIMNEY-REPAIR <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ 7,200.00 <br /> NOTE: CHIMNEY REPAIR <br /> APPLICANT pERMIT FEE SCHEDULE 162.25 <br /> JACK PIXLEY SWEEPS INC. STATE SURCHARGE(VALUATION) 3.60 <br /> 4179 149TH AVE.NW TOTAL 165.85 <br /> ANDOVER,MN 55304 <br /> (763)422-0011 <br /> Minnesota State License#: BC-201833 <br /> OWNER <br /> SUNNARBORG&ALICIA KRASEN,MICHEAL <br /> 1795 SHADYWOOD RD <br /> P.O.BOX 81(NAVARRE <br /> WAYZATA,MN 5392) <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 aze <br /> requested in conformance with the tate Building C d This permit may be <br /> revoked at any time for due cau . <br /> �i 3t i �4 _ � i �-1 i� <br /> Applicant Permitee Signature Date sued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />