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CITY OF ORONO PERMIT NO.: 2010-01175 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 12/02/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS 200 TRUFFULA TR <br /> PIN 33-118-23-44-0039 <br /> LEGAL DESC MEADOW WOOD POND <br /> LOT 005 BLOCK 001 <br /> PERMIT TYPE ADVANCED PLAN REVIEW <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE ADVANCED PLAN REVIEW <br /> VALUATION $ 40,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 40,000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: REMODEL PERMIT <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:BUILDING PERMIT 2010-01176 <br /> APPLICANT ADVANCED PLAN REVIEW 373.26 <br /> LECY BROS CONSTRUCTION TOTAL 373.26 <br /> 15012 HWY 7 <br /> MINNETONKA,MN 55345 <br /> (952)746-3783 <br /> Minnesota State License#: 20325555 <br /> OWNER <br /> ADAMS,MR.&MRS. <br /> 200 TRUFFULA TR <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 l6nq(__e_ gua'o4_ / <br /> Applicant Permitee Signature Date Is d By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />