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CITY OF ORONO <br /> * Z 0 1 3 - PJ 1 0 7 5 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/15/2013 <br /> ORONO, MN 55356- <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 : $ 125,000.00 <br /> NO"I'E: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT: $ 125000.00 <br /> "1'YPE OF PERMIT THIS PAYMENT IS FOR: BUILD[NG PERMI"I' <br /> PERMIT#THIS PRE-PAYMENT IS TIED T0:2013-01076 <br /> APPLICANT ADVANCED PLAN REVIEW 784.39 <br /> TOM POTTER CONSTRUCTION INC. TOTAL 784.39 <br /> 6531 DEVONSHIRE DR. <br /> CHANHASSEN, MN 55317 PAID WITH CC# 2887 <br /> �) <br /> Minnesota State License#: BCLi0144 <br /> OWNER <br /> BURWELL, MR. & MRS. RODNEY P <br /> 1100 MILLSTON ROAD <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 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 ol'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 l80 days of the date of issuance,or if construction is <br /> suspended for a period of I 80 days at any time after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conf ance with the State Building Code.This permit may be <br /> revok y for due cause. <br /> ��L�.Y�'�� l�l (�'-l?�v13 / l <br /> A plicant Permitee Signature Date Issued y S' ature ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED A E. <br />