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� � CITY OF ORONO PERMIT NO.: 2009-00495 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DA'rE IssuEn: O8/17/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 980 FERNDALE RD W <br /> PIN : 02-117-23-44-0019 <br /> LEGAL DESC : COUNTRY CLUB ESTATES <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:$ 60000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: BUILDING <br /> PERMIT#THIS PRE-PAYMENT IS"1'IED TO: 2009-00496 <br /> APPLICAI�TT ADVANCED PLAN REV[EW 491.89 <br /> SAFAR,JACK TOTAL 491.89 <br /> 980 FERNDALE RD W <br /> WAYZATA, MN 55391- PAID WITH CC# 8792 <br /> OWNER <br /> SAFAR, JACK <br /> 980 FERNDALE RD W <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 /> State Building Code. This permit is for only[he 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 l80 days a[any time after work has commenced. <br /> The applicant is responsible f suring all required inspections are <br /> requested in conformance w e State Building Code.This permit may be <br /> revoked at any ti f d use. <br /> / //"- d <br /> / / <br /> Applicant Per � a ure Date Issue By S' ature ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A E. <br />