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CITY OF ORONO * 2 0 1 5 — 0 0 0 1 3 * <br /> '� 2750 KELLEY PARKWAY DATE ISSUED: OU05/2015 <br /> j ORONO, MN 55356- <br /> (952) 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 517 FERNDALE RD N <br /> PIIv : 36-118-23-14-0007 <br /> LEGAL DESC : UNPLATTED 36 118 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> COIYSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 1,300,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT: $ 1,300,000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: NEW HOME <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2015-000 l4 <br /> NOTE:FEES HAVE INCREASED 5%,BUT SYSTEM HAS NOT BEEN UPDATED YET. `A DIFFERENCE ON THE ADVNACED PLAN <br /> REVIEW MAY BE DUE WHEN YOU PICK UP THE BUILDING PERMIT. INITIAL: �,,=-• <br /> APPLICANT ADVANCED PLAN REVIEW 4,651.89 <br /> TOTAL 4,651.89 <br /> DENALI CUSTOM HOMES, INC. Payment(s) <br /> 18283 MINNETONKA BLVD. CHECK 11236 4,651.89 <br /> DEEPHAVEN,MN 55391- <br /> (952)476-2679 <br /> Minnesota State License#: BUIL-20175394 <br /> OWNER City ot Uron� <br /> 275U Kelley Parkway <br /> Orono MN 55356 952-2d9-46UU <br /> BURNET,RALPH&PEGGY <br /> 392 FERNDALE RD Receipt No: 3.012551 Jan 5, 2015 <br /> WAYZATA,MN 55391- <br /> Denali Custom Homes <br /> Previous Balance: .00 <br /> Permits <br /> AGREEMENT AND SWORN STATEMENT 2015-OOU13 517 Ferndale 4,651.39 <br /> Rd N <br /> The work for which this permit is issued shall be performed according to 101-34410 <br /> the approved plans and specifications,applicable City approvals,and the Plan CheCk/S1 te txam Fees <br /> State Building Code. This permit is for only the work described and does Tot21: 4,651.89 <br /> not grant permission for additional or related work which requires separate ___,_______i__ <br /> permits. All provisions of laws and ordinances governing this type of work Cheek <br /> shall be compied with whether or not specified herein.This permit will Check No: 11236 4,651.�9 <br /> expire and become null and void if construction authorized is not Payor: <br /> commenced within 180 days of the date of issuance,or if construction is Denal l Cust�m Homes <br /> suspended for a period of 180 days at any time after work has commenced. Tn ta 1 App 11 ed: 4,651.;.'+ <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with the State Building Code.This permit may be 'hai r i�� 1.��i�i�,��i e�1. U��� <br /> revo ed at any time for d cause. <br /> � � � <br /> ` � � �ti .��.� IYY�Cc�'� � / � / � c <br /> � <br /> Ap a�ca ermitee ' nature Date Issued By Signature Date <br /> �u <br /> J <br />