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� � �` CITY OF ORONO PERMIT NO.: 2010-00955 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE �SSUEu: 10/08/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 4175 FOREST LAKE DR <br /> PIN : 07-117-23-11-0006 <br /> LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN <br /> : LOT 007 BLOCK 003 <br /> PERMIT TYPE : MINOR ALTERATIONS <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTIOIY TYPE : WINDOWS <br /> ACTIVITY : O/S BUILDING-UNDEFINED <br /> VALUATION : $ 4,144.00 <br /> NOTG: (4)WINDOW REPLACEMENTS IN EXISTING OPENINGS <br /> APPLICANT PERM[T FEE SCHEDULE 118.00 <br /> THE HOME DEPOT A.H.S. STATE SURCHARGE(VALUATION) 5.00 <br /> 2690 CUMBERLAND PKWY, STE 300 <br /> 30339- TOTAL 123.00 <br /> (763)542-8826 <br /> Minnesota State License#:20268257 <br /> OWNER <br /> THEISEN, T& S <br /> 4175 FOREST LAKE DR <br /> MOUND, MN 55364 <br /> AGREEMENT AND SWORN STATEMENT <br /> I�he work tbr which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and thc <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 type of work <br /> shall be compicd 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 l80 days at any time after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requcsted in conformance with the State Building Code.This permit may be <br /> revoked at any time for duc cause. <br /> ��� /Ll � l /lj �� � � � <br /> Applicant Permitee�ignature Date Iss d By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />