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CITY OF ORONO * 2 0 1 5 - 0 1 3 0 8 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/14/2015 <br /> ' ORONO, MN 55356- <br /> ' (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2450 COUNTRYSIDE DR <br /> PIN : 04-117-23-11-0004 <br /> LEGAL DESC : COUNTRYS[DE MANOR <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : ADDITION/REMODEL/REPAIR <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR <br /> ACTNITY : 434-RESIDENTIAL <br /> VALUATION : $ 5,000.00 <br /> NOTE: SEPARATE PERMITS REQUIRED:PLUMBING,ELECTR[CAL(STATE) <br /> (REMODEL POWDER BATH&MASTER BATH) <br /> APPLICANT PERMIT FEE SCHEDULE 123.91 <br /> PLAN REVIEW 80.54 <br /> WINKLER, SHAUN&STACIA STATE SURCHARGE(VALUATION) 2.50 <br /> 2450 COUNTRYSIDE DR <br /> LONG LAKE, MN 55356- TOTAL 206.95 <br /> Payment(s) <br /> CHECK 2459 206.95 <br /> OWNER <br /> WINKLER, SHAUN& STAC[A <br /> 2450 COLTNTRYSIDE DR <br /> LONG LAKE, MN 55356- <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 no[specified herein.This pemii[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 after work has commenced. <br /> The applicant is responsible for assuring all required inspections aze <br /> requested in conformance with the State Building Code.This permit may be � <br /> revoked at any time for due cause. -� <br /> i <br /> /`-'— �O / I.S � � �'� '�� /�..lt��� ��/ I�� l �� <br /> plicant Permitee Signature Dat Issued By Signature Date <br />