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CITY OF ORONO * Z 0 1 7 — PJ PJ 1 5 6 * <br /> , 2750 KELLEY PARKWAY DATE ISSUED: 02/2U2017 <br /> � ORONO, MN 55356- <br /> ' (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3188 NORTH SHORE DR <br /> PIIY : 09-117-23-32-0011 <br /> LEGAL DESC : CRYSTAL BAY PARK <br /> : LOT 000 BLOCK 004 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REV[EW <br /> VALUATION : $ 15,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 15,000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: IN-GROUND POOL <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2017-00155 <br /> APPLICANT ADVANCED PLAN REVIEW 18120 <br /> TOTAL 1 S 1.20 <br /> PERFORMANCE POOL&SPA Payment(s) <br /> 2405 ANNAPOLIS CHECK 1559 181.20 <br /> PLYMOUTH, MN 55441- <br /> (763)270-1180 <br /> OWNER <br /> RUCINSKI, MICHEAL& HOLLY <br /> 3188 NORTH SHORE DR <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 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 180 days at any time afrer 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 /> revok a i for due cause. <br /> � <br /> � �� <br /> j - L } � <;CF�S._-'1 � -t�L���L � � Z � � <br /> ( Y <br /> Applicant Permitee Signa re Date Issued By Signature Date <br />