HomeMy WebLinkAbout2011-00301 - adv plan review CITY OF ORONO PERMIT NO.: 2011-00301
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: OS/10/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 395 SUSSEX LA
PIN : 04-117-23-24-0007
LEGAL DESC : FOX BEND
: LOT 006 BLOCK 001
PERMIT TYPE : ADVANCED PLAN REVIEW
- PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 44,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ $44,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: BUILDING PERMIT
PERMIT#THIS PRE-PAYMENT IS TIED TO: 20 1 1-003 02
APPLICANT ADVANCED PLAN REVIEW 401.21
MANTIS DESIGN&BUILD TOTAL 401.21
465 NEWTON AVE S
MINNEAPOLIS,MN 55405- PAID WITH CC# 1537
(612)377-0123
Minnesota State License#:20470400
OWNER
CAMPBELL,JON&SUSAN
395 SUSSEX LA
LONG LAKE, MN 55356
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time aRer work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
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Applicant Permitee Signature Date Issued B ' ature e
t SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB .
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