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CITY OF ORONO * Z 0 1 2 — 0 0 9 4 8 * <br /> 2750 KELLEY PARKWAY nATE lssu�n: 09/26/2012 <br /> ORONO, MN 55356- <br /> �„. (952) 249-4600 FAX: (952) 249-4616 <br /> �DDRESS : 4175 FOREST LAKE DR <br /> PIN : 07-117-23-11-0006 <br /> LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN <br /> : LOT 007 BLOCK 003 <br /> PERMIT TYPE : ADDITION/REMODEL/REPAIR <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ 4,000.00 <br /> NOTE: REPLACE OLD CEDAR DECK BOARDS AND SPINDLF,S ON DGTACI IED DGCK. <br /> APPLICANT PERMIT FEE SCHEDULE 103.25 <br /> THEISEN, T& S STATE SURCHARGE(VALUATION) 2.00 <br /> 4175 FOREST LAKE DR <br /> MOUND, MN 55364 TOTAL 105.25 <br /> PAID WITH CC# 9759 <br /> OWNER <br /> THEISEN, T& S <br /> 4175 FOREST LAKE DR <br /> MOUND, MN 55364 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for���hich this permit is issued shall be performcd according to <br /> the approved plans and specifications,applicable Ciry 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�aork <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 /> conunenced within 180 days of the date of issuance,or if construc[ion is <br /> suspended for a period of 180 days at any time aCter work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in confonnance with the State[3uilding Code.This pern�it may be <br /> revoked at any time for due cause. /�j <br /> ���'7 l"l�C-:=�'t��' C %l,�,/- � / �--. ��� �_c._� c",)�-�c �-� � (�-- �� (` /^ <br /> Rpplicant Yermitee Signature Da�e- Issued By Signature Datc <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />