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• CITY OF ORONOI �il I� �' 111!1' �'I 11I�!11 H <br /> City of Orono * 20 14 - 01375 * <br /> 2750 Kelley Parkwa; 2750 KELLEY PARKWAY DATE ISSUED: 11/26/2014 <br /> Orono MN 55356 952-249-4600 ORONO, MN 55356- <br /> Receipt No: 3.012375 Nov 26, 2014 ,) 249-4600 FAX: (952) 249-4616 <br /> Schwarz Builders 3 LAKE RD <br /> Previous Balance: .00 014 <br /> Permits PION <br /> 2014-01375 450 Old Long 1,271.89 <br /> Lake Rd LOCK 001 <br /> 101-34410 'LAN REVIEW <br /> Plan Check/Site Exam Fees <br /> Total: 1,271.89 <br /> 'LAN REVIEW <br /> Credit Card TIAL <br /> Check No: 1993 1,271.89 <br /> Payor: <br /> Schwarz Builders <br /> Total Applied: 1,271.89 <br /> Change Tendered: .00 <br /> 11/26/2014 12:55PM <br /> ITION <br /> 1.01376 <br /> I agree to Pas above total amount <br /> according to card issuer agreement <br /> (Merchant agreement if credit voucher) <br /> Irj ,NT ADVANCED PLAN REVIEW 1,271.89 <br /> v. <br /> TOTAL 1,271.89 <br /> Payment(s) <br /> Merchant Coax .TE 2 CREDIT CARD 1993 1,271.89 <br /> THANK You. <br /> HAVE A NICE DAY. -BC003922 <br /> OWNER <br /> POLICINSKI, CHRISTOPHER&ANNE <br /> 450 OLD LONG LAKE RD <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 after 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 /> �/ �/ y <br /> Applicant Permitee Signature Date lssu By Signature Date <br />