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CITY OF ORONO * z 0 1 5 - 0 � 1 1 6 * <br /> - � 2750 KELLEY PARKWAY DATE ISSUED: OU23/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 4565 BAYSIDE RD <br /> PIN : 06-117-23-21-0010 <br /> LEGAL DESC : BAYSIDE BERRY FARM <br /> : LOT 2 BLOCK 1 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 1,270,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 1,27Q000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: NEW HOME <br /> PF,RMIT#THIS PRE-PAYMENT IS TIED TO:2015-00115 <br /> APPLICANT ADVANCED PLAN REVIEW 4,802.58 <br /> DENALI CUSTOM HOMES, INC. TOTAL 4,802.58 <br /> Payment(s) <br /> 18283 MINNETONKA BLVD. CHECK 11274 4,802.58 <br /> DEEPHAVEN, MN 55391- <br /> (952)476-2679 <br /> Minnesota State License#: BUIL-20175394 <br /> i;i ty u f Dronc, <br /> 2750 Kelley Parkway <br /> OWNER Orono MN 55356 952-249-4600 <br /> Raceipt No: 3.012680 Jan 23, 2015 <br /> DOUBECK, TIM& MARY <br /> 4565 BAYSIDE RD Denali Custom Homes <br /> MAPLE PLAIN, MN 55359- <br /> Previous Balance: .00 <br /> Permits <br /> 2015-00116 4565 Bayside 4.8U2.58 <br /> Rd <br /> AGREEMENT AND SWORN STATEMENT 101-34410 <br /> Plan Check/�ite Exam Fees <br /> 'I'he work for which this permit is issued shall be performed according to ------ �---`-' <br /> the approved plans and specifications,applicable City approvals,and the Tot81: 4,8U2.58 <br /> State[3uilding Code. This permit is for only the work described and does ---------"----- <br /> not grant permission for additional or related work which requires separate Check <br /> permits. All provisions of laws and ordinances governing this type of work Cheek No: 11274 4.8UL.53 <br /> shall be compied with whether or not specified herein.This permit will Payor: <br /> Denali Custum Homes <br /> expire and become null and void if construc[ion authorized is not Tota 1 Aon 1 j��+• <br /> commenced within 180 days of Ihe 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. :� f /Zf> <br /> � / <br /> C� l " � �(` '� � lL-�--�/ �S _ <br /> Applicant Permitee Signature Date Issued By ignature Date <br />