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. • � CITY OF ORONO PERMIT NO.: 2010-00697 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE IssuEn: 08/1 U2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2515 COUNTRYSIDE DR <br /> PIN : 04-117-23-11-0007 <br /> LEGAL DESC : COUNTRYSIDE MANOR <br /> : LOT 003 BLOCK 002 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 20,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 20000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: BUILDING <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2010-00 <br /> APPLICANT ADVANCED PLAN REVIEW 220.51 <br /> BUILDERS BY DESIGN TOTAL 220.51 <br /> 21185 VIKING BLVD. <br /> WYOMING,MN 55092- PAID WITH CC# 1097 <br /> Minnesota State License#: 20026555 <br /> OWNER <br /> KAHLER, CHRIS& DELPHINE <br /> 2515 COUNTRYSIDE DR <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 gran[permission for additional or related work which cequires separate <br /> permits. All provisions of laws and ordinances goveming 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 re�onsible for assuring all r�quired inspections are <br /> requested in con ormance wit}f'the State$nyYding.Code.This permit may be <br /> revoked at any ime for du�rcause. <br /> _ / ,, <br /> .� /��/ l� / / <br /> App�cant Permitee Signafure Date Issued By S� ature Date <br /> � SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED ABO <br />