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CITY OF ORONO PERMIT NO.: 201�-oo9s2 <br /> 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE ISSUED: 09/OU2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1100 MILLSTON RD <br /> PIN : 10-117-23-14-0015 <br /> LEGAL DESC : MILLSTON <br /> : LOT 000 BLOCK 001 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 250,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$250000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: POOL CABANA <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2011-000983 <br /> APPLICANT ADVANCED PLAN REVIEW 1,271.89 <br /> TOM POTTER CONSTRUCTION INC. TOTAL 1,271.89 <br /> 6531 DEVONSHIRE DR. <br /> CHANHASSEN,MN 55317 PAID WITH CC# 2887 <br /> �) <br /> Minnesota State License#:20130144 <br /> OWNER <br /> BURWELL,MR.&MRS.RODNEY P . <br /> 7901 XERXES AVE S <br /> BLOOMINGTON,MN 55431- <br /> AGREEMENT AND SWORN STATEMENT <br /> 7'he work for which this permit is issued shall be performed according[o <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 /> shail 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 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 />