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CITY OF ORONO * z 0 1 2 — 0 0 9 7 5 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/28/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> � REPRINTED ON 9/28/2012 <br /> A�`JuRESS : 3350 FOX ST <br /> PIN : OS-117-23-44-0008 <br /> LEGAL DESC : FULLERTON ESTATES <br /> : LOT 004 BLOCK 001 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 10,000.00 <br /> NOTE: PLEASG FILL IN THG FOLLOWING: <br /> VALUATION OF PERMIT:$ 10000.00 <br /> TYPE OF PGRMIT THIS PAYMENT IS FOR: E3UILDING PGRMIT-MONUMENTS <br /> PGRMIT# TH[S PRE-PAYMENT IS"I'IED TO:2012-00976 <br /> APPLICANT ADVANCED PLAN REVIEW 124.64 <br /> S�'EINER& KOPPELMAN TOTAL 124.64 <br /> 18340 MINNETONKA BLVD <br /> DEEPHAVEN, MN 55391- PAID WITH CC# ]072 <br /> (612)473-5435 <br /> Minnesota State License#: 3721 <br /> OWNER <br /> BIGOS,NANCY <br /> 3350 FOX ST <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issucd shall be performed accordin�to <br /> the approved plans and specifications,applicable City approvals,and the <br /> Sta[e 13uilding Code. This permit is for only the work described and does <br /> not grant permission for additional or related work which requires separate <br /> permi[s. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specified hercin.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 aIler work has commenced. � <br /> The applicant' � onsible for assuring all required inspections are <br /> rcquested� confor anc the State Building Code.This permit may be <br /> revoke t any ti e due ausc. <br /> � / .�.`�/ � � / / <br /> Ap licant ermitee �gnature Dale Issued By Si ature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO . <br />