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WCITY OF ORONO 11111111t11111,111111111111 I I I II 1 <br /> 2750 KELLEY PARKWAY <br /> * 20 1 6 — PJ 1 3 4 3 <br /> DATE ISSUED: 11/21/2016 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 500 OLD CRYSTAL BAY RD S <br /> PIN : 1000184 <br /> LEGAL DESC : CRYSTAL BAY RETREAT <br /> : LOT 1 BLOCK 1 <br /> PERMIT TYPE : NEW STRUCTURE <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : SINGLE FAMILY <br /> ACTIVITY : 101- INGLE FAMILY HOUSES,DETACHED <br /> VALUATION : $ 51 ,765.00 <br /> NOTE: SEPARATE PERMITS REQUIRE :PLUMBING,MECHANICAL,SEPTIC,FIREPLACE,WELL(STATE),ELECTRICAL(STATE) <br /> NOTE:PLEASE SEE AND INITIAL NEW BUILDER ACKNOWLEDGEMENT FORM <br /> APPLICANT PERMIT FEE SCHEDULE 3,724.42 <br /> PLAN REVIEW 204.75 <br /> NORTON HOMES STATE SURCHARGE(VALUATION) 258.88 <br /> 18215 45TH AVE N, STE D TOTAL 4,188.05 <br /> PLYMOUTH,MN 55446- <br /> (763)559-2991 Payment(s) <br /> Minnesota State License#:BUIL-BC63 221 CHECK 14685 4,188.05 <br /> OWNER <br /> GEORGE FUNK&JUDY ROGOSHES,KE <br /> 540 OLD CRYSTAL BAY RD S <br /> LONG LAKE,MN'55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be rformed according to <br /> the approved plans and specifications,applicable ity approvals,and the <br /> State Building Code. This permit is for only the w rk described and does <br /> not grant permission for additional or related work hich 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 issuanc ,or if construction is <br /> suspended for a period of 180 days at any time after work has commenced. <br /> The applicant is responsible for assuring all requir inspections are <br /> requested in conformance with the State Building 9ode.This permit may be <br /> revoked at any time for due cause. <br /> Applicant Permitee Signature Date Issued By Signature Date <br />