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CITY OF ORONO * 2 0 1 4 - 0 0 1 4 6 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 02/19/2014 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952 249-4616 <br /> ADDRESS : 1065 FERNDALE RD W <br /> PIN : 02-117-23-43-0021 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1372 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 200,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ $200,000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: BUILDING PERMIT-REMODEL <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2014-00146 <br /> APPLICANT ADVANCED PLAN REVIEW 1,076.89 <br /> TOTAL 1,076.89 <br /> REVISION LLC Payment(s) <br /> 10985 OAK SHORE TRAIL CREDIT CARD 6301 1,076.89 <br /> DELANO,MN 55328- <br /> (952)540-7150 <br /> Minnesota State License#: BUIL-BC639027 <br /> OWNER <br /> TRUSTEE,JANE NELSON <br /> 1065 FERNDALE RD W <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 /> �....__.__, �` <br /> �... <br /> �C, __ _. .,_.� ,� 2 , ( / �� / / <br /> App ic�Perw6it'�e�S�ur Date Issued By Si ture Date <br />