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� , �_ CITY OF ORONO * 2 PJ 1 4 — 0 0 6 0 2 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/16/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3655 NORTH SHORE DR <br /> PIN : 08-117-23-34-0050 <br /> LEGAL DESC : CRYSTAL BEACH Ci ty of uronc; <br /> . LOT 000 BLOCK 000 �750 Kel iey Park;��iy <br /> PERM[T TYPE . ADVANCED PLAN REVIEW ��r ono MN 55366 ��52-2A9-�16u�i <br /> PROPERTY TYPE . RESIDENTIAL Receipt No: :�.011135 Jun 16, �'ul-; <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 230,000.00 A1 Nagen <br /> NOTG: PLEASE FILL IN"I HE FOLLOWINU: <br /> Previnus Balance: .0�� <br /> VALUATION OF PERM[T: $ 230,000.00 Fer�oits <br /> 1'YPG OF PERMIT THIS PAYMENT IS FOR: NEW HOME Plan Review i,19?.�3c'• <br /> 101-34410 <br /> PERMIT#THIS PRE-PAYMENT IS TIED T0:2014-000602 �'l�n l',hecki5it�. Exam Fees <br /> Total: 1,19;7.59 <br /> cn�rk <br /> Check No: 5011 l.ly3 8�� <br /> Payor : <br /> �+1 <br /> , , <br /> APPLICANT ADVANCED PLAN REVIEW 1,193.89 <br /> TOTAL 1,193.89 <br /> GOLDEN HOME BUILDERS INC. Payment(s) <br /> 525 TAMARACK AVB CHECK SOl l 1,193.89 <br /> LONG LAKE, MN 55356- <br /> (952)476-0237 <br /> Minnesota State License#: BUIL-003716 <br /> OWNER <br /> HAGEN,AL& DONNA <br /> 3655 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 speeifications,applicable City approvals,and the <br /> State Building Code. This permit is fur 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 govcrning 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 thc date of issuance,or if construction is <br /> suspended for a period of 180 days at any time atter work has commenced. <br /> l�he applicant is responsible for assuring all required inspections are <br /> requested in conformance with the State Building Code.This permit may bc <br /> revoked at any time for due cause. <br /> �� �C-� ��I��d� ����� � <br /> Applicant Permitee Signature Date Issued By S' ature Date <br />