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CITY OF ORONO * z 0 1 5 - 0 0 9 0 2 * <br /> � ' 2750 KELLEY PARKWAY DATE ISSUED: 1U16/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1120 COX FARM RD <br /> PIN : 27-118-23-31-0021 <br /> LEGAL DESC : SHADOWOOD FARM <br /> : LOT 005 BLOCK 001 <br /> PERMIT TYPE : ADDITION/REMODEL/REPAIR <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ 35,000.00 <br /> NOTE: SEPARATE PERMITS REQUIRED: ELECTRICAL(STATE) <br /> NOTE: PRIOR TO RELEASG OF ESCROW MONEY AN AS-BUILT SURVEY MUST BE SUBMITTED AND APPROVED. INfTIAL: �" � <br /> . <br /> APPLICANT PERMIT FEE SCHEDULE 546.55 <br /> STATE SURCHARGE(VALUATION) 17.50 <br /> TONY SCHREMPP CONSTRUCTION LLC <br /> 1450 81ST STREET TOTAL 564.05 <br /> VICTORIA, MN 55386- Payment(s) <br /> (952)443-2529 CHECK 3108 564.05 <br /> Minnesota State License#: BUIL-4357 <br /> OWNER <br /> WAGENER,GREGORY& LAURA <br /> 1 120 COX FARM RD <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 goveming this type of work <br /> shall be compied wi[h whether or no[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 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 /> �-� �._ k �- �G, ,� o Sti /l � ����� <br /> Applicant Permitee ture Date Issued By Sig re Date <br />