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CITY OF ORONO PERMIT NO.: 2011-01506 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 12/01/2011 <br /> j 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 315 TONKAWA RD <br /> PIN : 06-117-23-14-0021 <br /> LEGAL DESC : REG.LAND SURVEY NO.0540 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 175,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 175000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR:SMALL ADDITION FOR ELEVATOR <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2011-01507 <br /> APPLICANT ADVANCED PLAN REVIEW 979.39 <br /> JENSEN HOMES <br /> 601 CARLSON PARKWAY#1225 TOTAL 979.39 <br /> MINNETONKA,MN 55305- PAID WITH CC# 2152 <br /> (952)475-0548 <br /> Minnesota State License#: 1156 <br /> OWNER <br /> Waycrosse,Inc. <br /> MACMILLAN,MARTHA E <br /> 15407 MCGINTRY RD W <br /> WAYZATA,MN 55391- <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 /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />