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� CITY OF ORONO PERMIT NO.: 20o9-ooss2 <br /> � 2750 KELLEY PARKWAY <br /> � ORONO,MN 55356- DATE IssuEn: 09/1U2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3745 JACOBS MILL RD <br /> PIN : 32-118-23-24-0011 <br /> LEGAL DESC : JACOBS MILL <br /> : LOT 001 BLOCK 002 <br /> PERMIT TYPE : MINOR ALTERATIONS <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ROOFING-ASPHALT <br /> ACTIVITY : O/S BUILDING-UNDEFINED <br /> VALUATION : $ 15,000.00 <br /> APPLICANT pERMIT FEE SCHEDULE 265.50 <br /> CVA DESIGNS CONSTRUCTION STATE SURCHARGE(VALUATION) 7.50 <br /> 9637 ANDERSON LAKES PARKWAY <br /> EDEN PRAIRIE,MN 55344 MISC FEE 0.00 <br /> (612)216-5513 TOTAL 273.00 <br /> Minnesota State License#:20634594 <br /> OWNER <br /> ADAMS,BRADLEY&LYNN <br /> 3745 JACOBS MILL 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. 1'his permit is for only the work described and does <br /> not grant permission for additional or related work which requires sepazate <br /> permits. All provisions of laws and ordinances governing 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 conswction authorized is not <br /> commenced within 180 days of the date of issuance,or if conswction 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked tirpe for due cause. <br /> �� , i i i i <br /> Applicant Permitee Signature Date Issued By nature Da <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB . <br />