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CITY OF ORONO * 2 0 1 3 - 0 0 4 B 2 * 2750 KELLEY PARKWAY DATE ISSUED: 06/18/2013 � ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3515 SIXTH AVE N PIN : 29-118-23-43-0002 LEGAL DESC : UNPLATTED 29 118 23 : LOT 000 BLOCK 000 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW VALUATION : $ 80,000.00 NOTE: PLEASE FILL IN THE FOLLOWING: VALUATION OF PERMIT: $ $80000.00 TYPE OF PERMIT THIS PAYMENT IS FOR: BUILDING PERMIT PERMIT#THIS PR�PAYMENT IS TIED TO:2013-00483 APPLICANT ADVANCED PLAN REVIEW 589.39 MITTELSTAEDT INC TOTAL 58939 P O BOX 454 WATERTOWN,MN 55388- PAID WITH CC# 1074 (612)716-9595 Minnesota State License#:20012394 OWNER WOJCIESZAK,JOY 3515 SIXTH AVE N LONG LAKE, MN 55356- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires sepazate permits. All provisions of laws and ordinances goveming this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not " commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections aze requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. / / �Pll� lI Applicant Permitee Signature Date ' Issue y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.