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, • CITY OF ORONO PERMIT NO.: 2009-00910 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE �ssuE�: 12/2U2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3205 CRYSTAL BAY RD <br /> PIN : 17-117-23-41-0011 <br /> LEGAL DESC : TOWNSITE OF LANGDON PARK <br /> : LOT 001 BLOCK 002 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 175,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT: $ 175000.00 <br /> "t'YPE OF PERMIT THIS PAYMENT IS FOR L3UILDING <br /> PERM["1�#TH[S PRE-PAYMENT IS TIED TO:2009- Dp�j�� <br /> APPLICANT ADVANCED PLAN REVIEW 97939 <br /> ANDERSON, RICHARD TOTAL 979.39 <br /> 3205 CRYSTAL BAY RD <br /> WAYZATA,MN 55391- <br /> OWNER <br /> ANDERSON, RICHARD <br /> 3205 CRYSTAL BAY RD <br /> WAYZATA, MN 55391- <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 thc <br /> State Building Codc. This permit is for only the work described and docs <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing this typc 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 appiicant is responsible Yor assuring all required inspections are <br /> requested in conformance with the State Building Codc.This permit may be <br /> r voked at any time for due cause. <br /> C�;�.�C�.- � a. / (� / / <br /> Applicant Permitee Signature Date Issued By gnature D <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO <br />