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� <br /> �: CITY OF ORONO * z 0 1 6 - 0 0 6 1 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/OU2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> A1�DRESS : 4225 FOREST LAKE DR <br /> PIN : 07-117-23-12-0025 <br /> LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN <br /> : LOT 003 BLOCK 003 <br /> PERMIT TYPE : MINOR ALTERATIONS <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : SIDING <br /> ACT[VITY : O/S BULLDING- UNDEFINED <br /> VALUATION : $ 16,200.00 <br /> NOTE: RES[DING <br /> APPLICANT PERMIT FEE SCHEDULE 309.75 <br /> STATE SURCHARGE(VALUATION) 8.10 <br /> TWIN CITIES SIDING PROFESSIONALS MAIL-IN FEE 2.00 <br /> 664 TRANSFER RD. <br /> SUITE 22A TOTAL 319.85 <br /> ST. PAUL, MN 55114- Payment(s) <br /> (651)255-2844 CREDIT CARD 5620 319.85 <br /> Minnesota State License#: BUIL-BG2031110 <br /> OWNER <br /> ANDERSON, KENNETH <br /> 4225 FOREST LAKE DR <br /> MOUND,MN 55364 <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 pennit 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 l80 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. <br /> / ; <br /> % ' � "� � f �� <br /> �`�L`✓L�-� �l (r� / � / _ <br /> Applicant Permitee Signature � Date Issued y ignature Date <br />