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CITY OF ORONO * z 0 1 2 - 0 1 0 5 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/18/2012 <br /> ORONO, MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 2990 SUSSEX RD <br /> PIIv : 04-117-23-31-0020 <br /> LEGA�L DESC : FOX BEND <br /> : LOT 3 BLOCK 4 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 150,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 150000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: CABANA/POOL CHANGING ROOM AND PUMP HOUSE <br /> PERMIT#THIS PRE-PAYMENT IS"TIED TO:2012-01052 <br /> APPLICANT ADVANCED PLAN REVIEW 881.89 <br /> WIPO HOMES TOTAL 881.89 <br /> 15623 NORMANDY LANE <br /> MINNETONKA,MN 55345- PAID WITH CC# 4038 <br /> (612)396-6728 <br /> OWNER <br /> KELLY,NSTIN&SUSAN <br /> 2990 SUSSEX RD <br /> LONG LAKE,MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which[his 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 sepazate <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 are <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 /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />