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CITY OF ORONO PERMIT NO.: 2009-00645 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE ISSUE�: 09/29/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 175 CRYSTAL CREEK RD <br /> PIN : 33-118-23-33-0006 <br /> LEGAL DESC : CRYSTAL CREEK <br /> : LOT 005 BLOCK 001 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 23,500.00 <br /> TYPE OF PERMIT THIS PAYMENT IS['OR: BUILDING <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO: 2009-00644 <br /> APPLICANT ADVANCED PLAN REVIEW 258.86 <br /> INTEGRITY DESIGN&CONSTRUCTION INC <br /> 21140 HONEYCOMB PATH TOTAL 258.86 <br /> LAKEVILLE, MN 55044- PAID WITH CC# 9899 <br /> (952)985-5004 <br /> Minnesota State License#: 20004064 <br /> OWNER <br /> ENGEBRETON,ANDREW& SALLY <br /> 175 CRYSTAL CREEK RD <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AIYD 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 grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing 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 responsible for assuring all required inspections are <br /> requested in conformance with the State E3uilding Code.This permit may be � <br /> revoked at any time for duc cause. <br /> l l � �/�Y�. l l <br /> Applicant Permitee Signature Date [ssued B 'ignature Date <br /> SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED A VE. <br />