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CITY OF ORONO * Z 0 1 6 - 0 1 0 9 2 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/08/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRE"S : 2166 SHADYWOOD RD <br /> PIN � : 1'7-117-23-42-0011 <br /> LE('AL DESC : WILEYS PARK LAKE MTKA <br /> : LOT 000 BLOCK 001 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 78,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 78,000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: MAIN LEVEL REMODEL <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2016-01093 <br /> APPLICANT ADVANCED PLAN REVIEW 608.76 <br /> REVISION LLC TOTAL 608.76 <br /> 153 E LAKE STREET Payment(s) <br /> CHECK 12496 608.76 <br /> WAYZATA, MN 55391- <br /> (952)540-7150 <br /> Minnesota State License#: BUIL-BC639027 <br /> OWNER <br /> LACROIX, STEPHEN&SUSAN <br /> 2166 SHADYWOOD RD <br /> WAYZATA,MN 55391- <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 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 confo ance w�th e State Building Code.This permit may be j�-� <br /> revoked at t� e for d 'use. � �/ <br /> � , A� <br /> i <br /> %� `I-�-j(r ��� ;� �"`-c� 7`� �� ��� ��� � <br /> Ap 'ca�t Pe �ee Signature Date Issued By igna re Date <br />