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CITY OF ORONO PERMIT NO.: 2011-00865 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE IssUEu: 08/15/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 930 COX FARM RD <br /> PIN : 27-118-23-33-0013 <br /> LEGAL DESC : SHADOWOOD FARM <br /> : LOT O10 BLOCK 001 <br /> PERMIT TYPE : ADVANCED PLAN REV[EW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 400,000.00 <br /> NOTE: PLEASE FILL IN TEIE FOLLOWING: <br /> VALUATION OF PERMIT:$ 400,000.00 <br /> TYPE OF PF,RMI"I�THIS PAYMENT IS FOR: REMODEL <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2011-00866 <br /> APPLICANT ADVANCED PLAN REVIEW 1,856.89 <br /> VIKING CONSTRUCTION, WC. TOTAL 1,856.89 <br /> 871 JEFFERSON AVE. <br /> ST.PAUL, MN 55102- PAID WITH CC# 0251 <br /> (651)222-3065 <br /> Minnesota State License#: 20332522 <br /> OWNER <br /> KILLINGSTAD, MR. &� <br /> 930 COX FARM RD <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORN STATEMENT <br /> Thc work for which this permit is issued shall be performed according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> State Building Code. This permit is for oniy 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 goveming this type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and bccome null and void if construction authorized is not <br /> commenced within 180 days of the date of issuance,or if construc[ion is <br /> suspended for a period of 180 days at any time after work has commenced. <br /> The applicant is responsibl assuring all required inspections are <br /> requested in conforma ith[he State Building Code.This permit may be <br /> revoke or due cause. <br /> o�' �� - � � �/l�.S' l�� (;�9/ZyC.�-� l l <br /> Applicant,�ermitec Signal�re Date Issued By S' ature Date <br /> / - SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB . <br />