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CITYOFORONO * 201z - 00608 * 2750 KELLEY PARKWAY DATE ISSUED: 06/26/2012 ORONO, MN 55356- � . (952)249-4600 FAX: (952) 249-4616 A„T'.�DRESS : 2990 SUSSEX RD . PIN : 04-117-23-31-0020 LEGAL DESC : FOX BEND : LOT 3 BLOCK 4 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW VALUATION : $ 275,000.00 NOTE: PLEASE FILL IN THE FOLLOWING: VALUATION OF PERMIT:$275,000.00 TYPE OF PERMIT THIS PAYMENT IS FOR: BATHROOMS AND MASTER CLOSET REMODEL PERRMIT#THIS PRE-PAYMENT IS TIED TO:2012-00609 APPLICANT ADVANCED PLAN REVIEW 1,369.39 WILLIAM POHLEN 15623 NORMANDY LANE TOTAL 1,369.39 MINNETONKA,MN 55345- PAID WITH CC# 4038 Minnesota State License#:20267452 OWNER KELLY,JUSTIN&SUSAN 2990 SUSSEX RD LONG LAKE,MN 55356- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be perfortned according to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and dces not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances governing 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 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.