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CITY OF ORONO I*I I I I I I I I I I I I III <br /> 2750 KELLEY PARKWAY DATE ISSUED: 01/11/2018 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952)249-4616 <br /> ADDRESS : 2695 COUNTRYSIDE DR W <br /> PIN : 04-117-23-13-0005 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 005 BLOCK 003 <br /> PERMIT TYPE : ADDITION/REMODEL/REPAIR <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ 30,000.00 <br /> NOTE: SEPARATE PERMITS REQUIRED: ELECTRICAL(STATE) <br /> BASEMENT REMODEL <br /> APPLICANT PERMIT FEE SCHEDULE 490.12 <br /> STATE SURCHARGE(VALUATION) 15.00 <br /> LITE CONSTRUCTION <br /> (320)275-3677 TOTAL 505.12 <br /> Minnesota State License#:BUIL-1450 Payment(s) <br /> CREDIT CARD 2619 505.12 <br /> OWNER <br /> BICKETT, SCOTT&HOLLY <br /> 2695 COUNTRYSIDE DR W <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 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 a y time for ue cause. <br /> 1 ‘- e , <br /> Applicant Permitee Signature Date Issued Signature Date <br />