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CITY OF ORONO * 2 0 1 4 - 0 0 8 2 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 08/O1/2014 e <br /> ORONO, MN 55356— <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2630 COUNTRYSIDE DR W <br /> PIN : 04-117-23-12-0015 <br /> LEGAL DESC : OLD CRYS7'AL BAY ROAD ADDN <br /> : LOT 007 BLOCK 002 <br /> NFRMIT TYPE : ADVANCED VLAN REV[EW <br /> PROPEKTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 98,000.00 <br /> NO"I�1�;: PLEnSE FIL1,[N THE FOLLOWING: <br /> VALUATION OP PLRMI"C $ 98000.00 <br /> TYPE OF PERMI'C"CHIS PAYMENT IS FOR: BUILDING PF;RMIT <br /> PEKMIT#T}IIS VRE-PAYMGNT[S TII�D T0:2014-00824 <br /> APPLICANT ADVANCED PLAN REVIEW 677.14 <br /> TOTAL 677.14 <br /> PHEASAN'T RUN CONSTRUCTION Payment(s) <br /> 1 109 141ST LANE NE CREDIT CARD 4403 677.14 <br /> HAM LAKE, MN 55304 <br /> (763) 862-2106 <br /> Minnesota State License#: BUIL-20193061 <br /> OWNER <br /> URNESS, TODD& KATHERINE <br /> 2630 COUNTRYSIDE DR W <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 /> die approvcd plans and specifications,applicable City approvals,and the <br /> State f3uilding Code. This permit is for only the work described and does <br /> not grant permission for additional or rclated work which requires separate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compicd with whether or not specified herein.This permit will <br /> cxpire and become null and void if construction authorized is not <br /> commenced within 180 davs of the date of issuance.or if construction is <br /> suspended for a period of 180 days at any time aRer work has commcnccd. <br /> t�he applicant is responsible for assurine all required inspeclions are <br /> requested in conformance with thc State Eiuildina Cbde.This permit may bc <br /> revoked at anv time for due cause. <br /> l i <br /> "---_,.�=.��— _ _ �" �',� y / / <br /> _ __ ,� � <br /> Applicaitt� ermitee Signature Date Issued 13��Si � re ��Date <br />