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� CITY OF ORONO PERMIT NO.: 2009-00634 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 09/25/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> REPRINTED ON 9/25/2009 <br /> ADDRESS : 965 EDGEWOOD H[LLS RD <br /> PIN : 02-117-23-]4-0001 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1098 <br /> : LOT 000 BLOCK 000 <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: $ 263,000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION <br /> PERMI'I'#THIS PRE-PAYMENT IS TIED TO: 2009-00635 <br /> APPLICANT ADVANCED PLAN REVIEW 1,322.59 <br /> JAMES PATSCH CONST INC. TOTAL 1,322.59 <br /> 3427 HUMBOLT AVENUE S <br /> MINNEAPOLIS, MN 55408 <br /> (612)527-0111 <br /> Minnesota State License#: 4290 <br /> OWNER <br /> CUSICK, MR. & MRS. THOMAS <br /> 965 EDGEWOOD HILLS 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 the <br /> Statc[3uilding Code. This permit is for only the work described and does <br /> not gran[permission for additional or related work which requires separa[e <br /> permits. All provisions of laws and ordinances goveming this type of wark <br /> shall be compied with whe[her 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 aRer work has commenced. <br /> The applicant is responsible for assuring alI required inspections aze <br /> requested in conformance with the Sta[e Building Code.This permit may be <br /> revoked at any time for due cause. <br /> / / / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />