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, CITY OF ORONO * z 0 1 5 - 0 0 8 1 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/23/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1761 CONCORDIA ST <br /> PIN : 17-117-23-22-0017 <br /> LEGAL DESC : COFFEES ADDN TO SHADY WOOD LAK <br /> : LOT 011 BLOCK 000 <br /> PERMIT TYPE : MINOR ALTERATIONS <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WINDOWS <br /> ACTIVITY : O/S BUILDING-UNDEFINED <br /> VALUATION : $ 9,826.00 <br /> NOTE: REPLACE(6)WINDOWS [NTO EXISTING OPENINGS <br /> APPL[CANT PERMIT FEE SCHEDULE 201.36 <br /> STATE SURCHARGE(VALUATION) 4.91 <br /> RENEWAL BY ANDERSON MAIL-IN FEE 2.00 <br /> 1920 COUNTY RD C. WEST <br /> ROSEVILLE,MN 55113 TOTAL 208.27 <br /> (6l2)502-4777 Payment(s) <br /> Minnesota State License#: BUIL-BC 130983 CREDIT CARD 8788 208.27 <br /> OWNER <br /> HOLSTE, D HOLSTE& M <br /> 1761 CONCORDIA ST <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 gran[permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances goveming 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 applican[is responsible for assuring all required inspections are <br /> requested in conformance with[he State Building Code.This permit may be <br /> revoked a[any time for due cause. <br /> � �Glti C�G�� -� � 1��.� �J` <br /> Applicant Permitee Signature ' Date [ ued By Signature Date <br />