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CITY OF ORONO * Z 0 1 4 - 0 0 6 4 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/23/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3515 SIXTH AVE N <br /> PIN : 29-118-23-43-0002 <br /> LEGAL DESC : UNPLATTED 29 118 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> ACTNITY : 434-RESIDENTIAL <br /> VALUATION : $ 35,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 35,000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION <br /> PERMIT#THIS PRE-PAYMENT IS TIED T02014-00645 <br /> APPLICANT ADVANCED PLAN REVIEW 338.33 <br /> • TOTAL 338.33 <br /> MITTELSTAEDT INC Payment(s) <br /> 11730 BRADDOCK AVE SE CHECK 12070 33833 <br /> P O BOX 454 <br /> WATERTOWN, MN 55388- <br /> (612)716-9595 <br /> Minnesota State License#: BUIL-20012394 <br /> OWNER <br /> PETERSON,DALE&DIANE <br /> 3515 SIXTH AVE N <br /> LONG LAKE, MN 55356- <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 onty 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]80 days of the date of issuance,or if construction is <br /> suspended for a period of I 80 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 permit may be <br /> revoked at any time for due cause. <br /> / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br />