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� CITY OF ORONO P�arn1T No.: 2oii-oosio <br /> 2750 KELLEY PARKWAY <br /> ! ORONO, MN 55356- �ATE Iss[1En: 06/23/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 970 FOREST ARMS LA <br /> PIN : 07-117-23-11-0004 <br /> LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN <br /> : LOT 005 BLOCK 001 <br /> PERMIT TYPE : MINOR ALTERATIONS <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ROOFING -ASPHALT <br /> ACTIVITY : O/S BUILDING -LJNDEFINED <br /> VALUAT[ON : $ 6,800.00 <br /> APPLICANT PERMIT FEE SCHEDULE 147.50 <br /> JENSEN CONSTRUCTION SERVICES LLC STATE SURCHARGE(VALUATION) 3.40 <br /> 2620 GRANGER LN TOTAL 150.90 <br /> MOUND, MN 55364- <br /> (952)472-7223 PAID WITH CC# 3589 <br /> Minnesota State License#: 20639601 <br /> OWNER <br /> TRUSTEES, C& R LANGE <br /> 970 FOREST ARMS LA <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 permit is for only the work described and does <br /> not grant permission for addi[ional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing this type oY 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 applicant is responsible for assuring ali required inspections are <br /> requested in conYormance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> .�/��- �} ���-'�-=''—. � i �3 i -// i i <br /> Applicant Permitee ignature Date Issued By,'i nature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB . <br />