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iiiiiiiiiiiiiiiiiiiiiillillillillim <br /> y CITY OF ORONO * 2013 - 00468 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/13/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS 1000 WILLOW DR S <br /> PIN 10-117-23-21-0004 <br /> LEGAL DESC UNPLATTED 10 117 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE MINOR ALTERATIONS <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE WINDOWS <br /> ACTIVITY O/S BUILDING-UNDEFINED <br /> VALUATION S 12,828.00 <br /> NOTE: (5)WINDOW REPLACEMENTS IN EXISTING OPENINGS. <br /> APPLICANT PERMIT FEE SCHEDULE 236.00 <br /> PELLA NORTHLAND STATE SURCHARGE(VALUATION) 6.41 <br /> 15300 25TH AVE N. -SUITE# 100 <br /> PLYMOUTH,MN 55447 MAIL-IN FEE 2.00 <br /> (952)345-6047 TOTAL 244.41 <br /> Minnesota State License#: BC645090 <br /> OWNER <br /> KLOMBIES,LINDSAY&ANNA <br /> 1000 WILLOW DR S <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 after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance witlLthe State Building Code.This permit may be <br /> revoked at any time <br /> Afor <br /> 1ue cause. <br /> Applicant Permitee Signature Date Issued By Si ature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A . <br />