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� - CITY OF ORONO <br /> 2750 KELLEY PARKWAY * Z 0 1 4 - 0 1 2 6 7 * <br /> DATE ISSUED: 1 U04/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2680 PHEASANT RD <br /> PIN : 21-117-23-23-0020 <br /> LEGAL DESC : PHEASANT LAWN <br /> : LOT 020 BLOCK 000 <br /> PERMIT TYPE : ADDITION/REMODEL/REPAIR <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ 89,000.00 <br /> NOTE: SEPARATE PERMITS REQUIRED: PLUMBING,ELECTRICAL(STATE) <br /> BATH REMODEL <br /> APPLICANT PERMIT FEE SCHEDULE 974.25 <br /> C N OSTROM AND SON INC PLAN REVIEW 633.26 <br /> 23400 PARK ST STATE SURCHARGE(VALUATION) 44.50 <br /> PO BOX 758 TOTAL 1,652.01 <br /> EXCELSIOR,MN 55331- Payment(s) <br /> Minnesota State License#: BUIL-1907 CHECK 15329 1,652.01 <br /> OWNER <br /> DOLLIFF,MATTHEW&KATHY <br /> 2680 PHEASANT RD <br /> EXCELSIOR,MN 55331- <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 Ihe 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> , <br /> . � <br /> � �//�/'��f � � � / / � <br /> Applicant Permitee Signature Date Iss By Signature Date <br />