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CITY OF ORONO * Z 0 1 5 - 0 1 4 3 0 * <br /> � � 2750 KELLEY PARKWAY DATE ISSUED: 12/09/2015 <br /> • ORONO,MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 4645 ST.ANDREWS ST <br /> PIIv : T000121 <br /> LEGAL DESC : LAKEVIEW OF ORONO <br /> : LOT 14 BLOCK 3 <br /> PERMIT TYPE : NEW STRUCTURE <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : SINGLE FAMILY <br /> ACTIVITY : 101-SINGLE FAMILY HOUSES,DETACHED <br /> VALUATION : $ 950,000.00 <br /> NOTE: SEPARATE PERMITS REQUIRED:PLUMBING,MECHANICAL,SEPTIC,FIREPLACE,WELL(STATE),ELECTRICAL(STATE) <br /> NOTE:PLEASE SEE AND INITIAL NEW BUILDER ACKNOWLEDGEMENT FORM <br /> APPLICANT PERMIT FEE SCHEDULE 5,992.42 <br /> SWANSON HOMES STATE SURCHARGE(VALUATION) 475.00 <br /> 1360 HAMEL ROAD TOTAL 6,467.42 <br /> MEDINA,MN 55340- Payment(s) <br /> (763)478-0320 CHECK 36124 6,467.42 <br /> Minnesota State License#:BUIL-627982 <br /> OWNER <br /> Source Land Development Inc. <br /> 18215 45TH AVE N <br /> STE D <br /> PLYMOUTH,MN 55446- <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 dces <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 consWction 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 confortnance with the State Building Code.This permit may be <br /> revoked at any t' e for due cause. f <br /> �� �-- 0 �L a-, � ,/ S <br /> Applicant Pe itee Signature Date Issued By ignature Date <br />