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CITY OF ORONO PERMIT NO.: 2011-01553 <br /> 2750 KELLEY PARKWAY <br /> � ORONO,MN 55356- DATE ISSUED: 12/15/2011 <br /> y 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2900 DEER RUN TR <br /> PIN : 04-117-23-24-0013 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 008 BLOCK 004 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 300,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 300,000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2011-01554 <br /> APPLICANT ADVANCED PLAN REVIEW 1,466.89 <br /> MITTELSTAEDT INC TOTAL 1,466.89 <br /> P O BOX 454 <br /> WATERTOWN,MN 5538& <br /> (612)716-9595 <br /> Minnesota State License#:20012394 <br /> OWNER <br /> KACZKE,ROBERT&JILL <br /> 2900 DEER RUN TR <br /> LONG LAKE,MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this pertnit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Buiiding 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 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 /> l l �yt,�- /,�l /�i // <br /> Applicant Permitee Signature Date Issu By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />