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CITY OF ORONO * Z 0 1 4 - 0 0 6 4 2 * <br /> i 2750 KELLEY PARKWAY DATE ISSUED: 06/23/2014 <br /> ' ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDR S� : 3115 SUSSEX RD <br /> PIN : 04-117-23-32-0015 <br /> LEGAL I?ES : FOX BEND <br /> : LOT 004 BLOCK 002 <br /> PERMI TY : ADVANCED PLAN REVIEW <br /> PROPE TY PE : RESIDENTIAL <br /> CONST UC N TYPE : ADVANCED PLAN REVIEW <br /> ACTIVI Y . <br /> VALUA IION : $ 115,000.00 <br /> NOTE: �AS FILL IN THE FOLLOWING: <br /> VALUAT 01�1 O PERMIT:$ 115,000.00 <br /> TYPE OF ERM THIS PAYMENT IS FOR: REMODEL <br /> PERMIT#THIS -PAYMENT IS TIED T0:2015-00643 <br /> APPLICANT ADVANCED PLAN REVIEW 745.39 <br /> TOTAL 745.39 <br /> M. A. PE �S DESIGNBUILD Payment(s) <br /> 6161 WO D�A AVE. S CREDIT CARD 7738 745.39 <br /> EDINA, 55 4 <br /> (952)925- 455 <br /> Minnesota t�te cense#: BUIL-BC006704 <br /> OWNER <br /> MARY RA KO , DANIEL DELMORE& <br /> 3115 SUSS X <br /> LONG LA E, M 55356- <br /> AGR �M T AND SWORN STATEMENT <br /> The work for hich t i permit is issued shall be performed according to <br /> the approved lams an pecifications,applicable City approvals,and the <br /> State Buildin Cqde. is permit is for only the work described and does <br /> not grant pe 'ssion additional or related work which requires separate <br /> pertnits. All p ovisio of laws and ordinances governing this type of work <br /> shall be compi d with hether or not specified herein.This permit will <br /> expire and bec mle nu d void if construction authorized is not <br /> commenced w hun 18 ays of the date of issuance,or if construction is <br /> suspended for p�riod f 180 days at any time after work has commenced. <br /> The applicant i r�spo 'ble for assuring all required inspections are <br /> requested in co f4rma e with the State Building Code.This permit may be <br /> revoked at any irme fo ue cause. <br /> / / <br /> Applicant Pe i'tee nature Date Issued By Signature Date <br />