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CITY OF ORONO PERMIT NO.: 20��-00020 <br /> 2750 KELLEY PARKWAY � <br /> ORONO, MN 55356- DATE ISSUED: OU07/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2256 SHADYWOOD RD <br /> PIN : 17-117-23-43-0125 <br /> LEGAL DESC : WILEYS PARK LAKE MTKA <br /> : LOT 006 BLOCK 001 <br /> :' PERMIT TYPE : ADVANCED PLAN REVIEW <br /> '.. PROPERTY TYPE : RESIDENTIAL <br /> ' CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> ; VALUATION : $ 150,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 150,000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:20 1 1-0002 1 <br /> APPLICANT ADVANCED PLAN REVIEW 881.89 <br /> SHORELINE BUILDERS TOTAL 881.89 <br /> 2184 SHADYWOOD RD <br /> WAYZATA,MN 55391- PAID WITH CC# 7736 <br /> (763)506-0629 <br /> Minnesota State License#:20630814 <br /> OWNER <br /> DEHAVEN PETERSON, ELLEN <br /> 960 SHADY LA � <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 goveming this rype 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 /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />