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• CITY OF ORONO I 1 ' 1 IL <br /> I'�2750 KELLEY PARKWAY 2 DATT 1E ISS - 0007 4 <br /> UED: 01/22/2015 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952)249-4616 <br /> ADDRESS : 225,OLD CRYSTAL BAY RD S <br /> PIN : 04-117-23-24-0002 <br /> LEGAL DESC : AUDITOR'S SUBD.NO.230 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 500,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 500000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR:NEW HOUSE <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2015-00075 <br /> APPLICANT ADVANCED PLAN REVIEW 2,359.23 <br /> TOTAL 2,359.23 <br /> NIH HOMES <br /> Payment(s) <br /> 6840 213TH AVENUE CHECK 22439 2,359.23 <br /> ELK RIVER,MN 55330- <br /> (763)753-1750 <br /> Minnesota State License#:BUIL-BC419931 <br /> OWNER <br /> HAY,NORMAN <br /> 5685 ROSOF PKWY <br /> LONG GROVE,IL 60047- <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 atter 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 /> 1-e 6)/mc- i 2 2,i5 <br /> Applicant Permitee Signature Date Issues a Signature Date <br />