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CITY OF ORONO * 2 0 1 2 - 0 0 6 6 6 * 2750 KELLEY PARKWAY DATE ISSUED: 07/12/2012 ORONO, MN 55356- .. (952) 249-4600 FAX: (952)249-4616 ADDR�SS : 2850 SOMERSET LA PIN � : 04-117-23-21-0013 LEGAL DESC : OLD CRYSTAL BAY ROAD 2ND ADDN : LOT 006 BLOCK 003 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW VALUATION : $ 15,000.00 NOTE: PLEASE FILL IN THE FOLLOWING: VALUATION OF PERMIT:$ 15,000.00 TYPE OF PERMIT THIS PAYMENT IS FOR: 4'OR>RETAINING WALL PERMIT#THIS PR�PAYMENT IS TIED TO: PERMIT#2012-00665 APPLICANT ADVANCED PLAN REVIEW 172.58 BARKLEY LANDSCAPES TOTAL 172.58 10820 46TH PLACE N PLYMOUTH,MN 55447- PAID WITH CC# 9999 (612)598-9895 OWNER TRANGSRUD&TERRY RASMUSSEN,JON 2850 SOMERSET LA LONG LAKE,MN 55356- AGREEMENT AND SWORN STATEMENT The work for which this pertnit 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 aperiod of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. / / / / Applicant Permitee Signature Date Issued By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.