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ti <br /> t CITY OF ORONO PERMIT NO.: 2011-00797 <br /> 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE ISSUED: 08/04/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS 1030 TONKAWA RD <br /> PIN 08-117-23-13-0015 <br /> LEGAL DESC REG.LAND SURVEY NO.0617 City of Orono <br /> LOT 000 BLOCK 000 2750 Kelley Parkway <br /> Orono NN 55356 952-249- 600 <br /> PERMIT TYPE ADVANCED PLAN REVIEW <br /> Receipt No: 3.005119 Aug 4, 2011 <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW Keith Water & Associates <br /> VALUATION : $ 74,000.00 Previous Balance: .00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: Permits <br /> 2011-00797 1030 Tonkawa 560.14 <br /> VALUATION OF PERMIT:$ 74,000 Rd <br /> 101-34410 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR:REMODEL Plan Check/Site Exam Fees <br /> Total: 560,14 <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2011-00798 New Balance: 560.14- <br /> Check <br /> Check No: 67390 560.14 <br /> Payor: <br /> Keith Water i Associates <br /> Total Applied: 560.14 <br /> Change Tendered: _ .00 <br /> 08/04/2011 09:32AN <br /> APPLICANT ADVANeED PLAN REVIEW 560.14 <br /> KEITH WATERS&ASSOCIATES TOTAL 560.14 <br /> 6216 BAKER ROAD <br /> SUITE 110 <br /> EDEN PRAIRIE,MN 55346- <br /> Minnesota State License#: 1508 <br /> OWNER <br /> BREMER,DENNIS&CYNTHIA <br /> 1030 TONKAWA 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 /> Applicant Permitee Signature Date <br /> Issued0y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />