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� a � ' ' CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 2 - 0 1 0 5 2 * <br /> DATE ISSUED: 11/20/2012 <br /> � ORONO, MN 55356— <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ATiDRESS : 2990 SUSSEX RD <br /> PIN : 04-117-23-31-0020 <br /> LEGAL DESC : FOX BEND <br /> : LOT 3 BLOCK 4 <br /> PERMIT TYPE . Ac,�'ES�SO�.,,� 5 '_/ <br /> PROPERTY TYPE : RESIDENTIAL ` � <br /> CONSTRUCTION TYPE . , �E�/ <br /> ACTIVITY : 434-RESIDENTIAL � � <br /> VALUATION : $ 150,000.00 <br /> NOTE: SEPERATE PERMITS REQUIRED: PLUMBING,MECIIANICAL,SEPTIC CONNECTION,ELECTRICAL(STATE) <br /> CABANA <br /> *C.U.P.FOR BATHROOM/SHOWER/PLUMBING REQUIRED PRIOR TO RELEASE OF ESCROW.�•✓" (INITIAL) <br /> * SUBMITTAL OF ENCROACHMENT AGREEMENT REQUIRED PRIOR TO ESCROW RELEASE._�(INITIAL) <br /> *AS-BUILT SURVEY REQUIRED. �,� (INITIAL) <br /> APPLICANT pERMIT FEE SCHEDULE 1,356.75 <br /> WIPO HOMES STATE SURCHARGE(VALUATION) 75.00 <br /> 15623 NORMANDY LANE <br /> MINNETONKA,MN 55345- TOTAL 1,431.75 <br /> (612)396-6728 PAID WITH CC# 4038 <br /> OWNER <br /> KELLY,JUSTIN& SUSAN <br /> 2990 SUSSEX RD <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 only 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 governing 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 /> � ` // l Z� l Z�r2 � J/ l �o l/`� <br /> Applicant Permitee Signature Date ssued Signature Date <br /> � SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />