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CITY OF ORONO * z 0 1 5 - 0 1 2 3 1 * <br /> , 2750 KELLEY PARKWAY DATE ISSUED: 10/14/2015 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3349 CRYSTAL BAY RD <br /> p(N : 17-117-23-41-0023 <br /> LEGAL DESC : WALLACES ADDN TO VIL OF MTKA B <br /> : LOT O10 BLOCK 000 <br /> PERMIT TYPE : ADVANCED PLAN REV[EW <br /> PROPERTY TYPE : RES[DENT[AL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 90,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT: $90,000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2015-01232 <br /> APPLICANT ADVANCED PLAN REVIEW 670.18 <br /> TOTAL 670.18 <br /> S.J. FISHER CONSTRUCTION Payment(s) <br /> 70 FLORENCE DRIVE CHECK 5378 670.18 <br /> TONKA BAY, MN 55331- <br /> (952)474-6976 <br /> Minnesota State License#: BUIL-BC626515 <br /> city uf ��rono <br /> OWNER 2750 Ke]ley`Pa�kway <br /> Orono MN .,,.,6 �52-24�-4a00 <br /> LENSING,JULIE keceipt No: :s.U14452 uct 14, 2015 <br /> 3349 CRYSTAL BAY RD <br /> WAYZATA, MN 55391- Julie Lensing <br /> F�revious B81df1C�': .liU <br /> Perrni ts <br /> 2015-01231 3349 Crystal C10.18 <br /> AGREEMENT AND SWORN STATEMENT Bay Rd <br /> 101-340.10 <br /> The work for which this permit is issued shall be performed according to Plan CheCk/S1 tr Exam Fees <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 Tota 1: __,_____6 7U•1� <br /> not grant permission for additional or related work which requires separate CheCk <br /> permits. All provisions of laws and ordinances goveming this type of work L'heck No: 5378 6?U.1�i <br /> shall be compied with whether or not specified herein.This permit will p�ypr: <br /> expire and become null and void if construction authorized is no[ JUl le Lensi��g <br /> commenced within 180 days of the date of issuance,or if construction is Tn ta 1 Ann 1 i ari• 67U.1�� <br /> suspended for a period of l80 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. <br /> i <br /> nn �r (f ��� ��- �� � ��_ �� � ��- � � �l ��1 / ��- -- <br /> u �'�,C ls <br /> Ap icant Permitee Signature Dat Issued By Signature Date <br />