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CITY OF ORONO * 2 0 1 2 - 0 0 8 7 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/04/2012 <br /> ORONO, MN 55356- � <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 2172 SHADYWOOD RD <br /> PIN : 17-117-23-42-0010 <br /> LEGAL 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 : $ 1,350.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 1350.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: REFIGURING GARAGE DOOR <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2012-00872 <br /> APPLICANT ADVANCED PLAN REVIEW 35.26 <br /> TRUE NORTH HOMES INC TOTAL 35.26 <br /> 410 LAKEVIEW AVENUE <br /> TONKA BAY,MN 55331- <br /> (612)281-2540 <br /> Minnesota State License#:20636839 <br /> OW1vER <br /> DORE, STEVEN <br /> 6530 CABRIDGE ST <br /> MINNEAPOLIS,MN 55426- <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 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 aze <br /> requested in conformance with the State Building Code.This petmit may be <br /> revoked at any time for due cause. <br /> / / / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />