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, � CITY OF ORONO PERMIT NO.: 2011-00279 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE tss[1��: OS/03/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 780 BRIDGEWATER DR <br /> PIN : 33-118-23-12-0024 <br /> LEGAL DESC : STONEBAY FOURTH ADDITION <br /> : LOT 013 BLOCK 001 <br /> PERMITTYPE : MINORALTERATIONS <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCT(ON TYPE : ROOFING-ASPHALT <br /> ACTIVITY : O/S BUILDING - UNDEFINED <br /> VALUATION : $ 8,000.00 <br /> NO l�G: "I1:AR OFF REROOI� <br /> APPLICANT PERMIT FEE SCHEDULE 162?5 <br /> MIDWEST ROOFING <br /> 6541 SYCAMORE CT N STATE SURCHARGE(VALUATION) 4.00 <br /> MAPLE GROVE, MN 55369- TOTAL 16625 <br /> (763)427-9696 <br /> Minnesota State License#: 20637010 <br /> OWNER <br /> PLANK, LOUISE <br /> 780 BRIDGEWATER DR <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The�cork for which this permit is issued shall be performed according[o <br /> the approved plans and specifications,applicable Ciry approvals,and the <br /> State Buildinc Code. This permit is for only the work described and docs <br /> not grant pennission for additional or rclated work which requires separate <br /> permits. All provisions of la�vs and ordinances governing this type of work <br /> shall be compied with whether or not spccified herein.This pennit will <br /> expire and become null and void if construction authorized is not <br /> commenced wilhin 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 /> "I�he applicant is responsible lor assuring all required inspections are <br /> requestcd in conformance with the State Building Code.This permit may be <br /> revoked• any time Yor due cause. <br /> S ' 3 ' J� ��2 �S3 � � <br /> Applicant Permitee Signature Date Iss By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />