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� r CITY OF ORONO * Z 0 1 5 - 0 1 2 3 6 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 12/1U2015 <br /> � ORONO, MN 55356- <br /> 952 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 795 LAKEVIEW PKWY <br /> PIIY : T000108 <br /> LEGAL DESC : LAKEVIEW OF ORONO <br /> : LOT 3 BLOCK 2 <br /> PERIVIIT TYPE : NEW STRUCTURE <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : SINGLE FAMILY <br /> ACTNITY : 101-5[NGLE FAMILY HOUSES,DETACHED <br /> VALUATION : $ 487,000.00 <br /> NOTE: SEPARATE PERM[TS REQUIRED:PLUMBING,MECHAN[CAL,SEPTIC, F[REPLACE,WELL(STATE),ELECTRICAL(STATE) <br /> NOTE:PLEASE SEE AND INITIAL NEW BUILDER ACKNOWLEDGEMENT FORM <br /> APPLICANT PERMIT FEE SCHEDULE 3,548.02 <br /> PLAN REVIEW 151.73 <br /> GONYEA HOMES STATE SURCHARGE(VALUATION) 243.50 <br /> 6102 OLSON MEMORIAL HIGHWAY <br /> GOLDEN VALLEY, MN 55427- TOTAL 3,943.25 <br /> (612)741-9069 Payment(s) <br /> Minnesota State License#: BUIL-2459 CHECK 10550 3,943.25 <br /> OWNER <br /> Source Land Development Inc. <br /> 18215 45TH AVE N <br /> STE D <br /> PLYMOUTH, MN 55446- <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 Ciry 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 rype 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 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 /> �' � , � ��.�-��(� < <(� �fS <br /> � � � �- <br /> � � , , ,_ `�,�`�� ,�'� <br /> Applicant Permitee Signature Date [ssued By Signature Date <br />