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CITY OF ORONO * z 0 1 2 — 0 1 0 5 6 * <br /> 2750 KELLEY PARKWAY �ATE [ssuEn: 10/22/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRI�!3� : 2990 SUSSEX RD <br /> � <br /> PIN : 04-117-23-31-0020 � <br /> . <br /> LEGAL DESC : FOX BEND \ <br /> : LOT 3 BLOCK 4 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW \ <br /> PROPERTY TYPE : RESIDENTIAL \ <br /> CONSTRUCTION TYPE : ADVANCED PLAN REV[EW \ <br /> VALUATION : $ 130,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 130,000.00 <br /> T'YPE OF PERMIT THIS PAYMENT IS FOR: IN-GROUND POOL <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2012-01055 <br /> APPLICANT <br /> QUALITY POOLS ADVANCED PLAN REV[EW 803.89 <br /> 10350 WOODHILL BLVD TOTAL 803.89 <br /> LAKEVILLE, MN 55044 PAID WITH CC# 4948 <br /> (612)985-7665 <br /> OWIVER <br /> KELLY,JUSTIN& SUSAN <br /> 2990 SUSSEX RD <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this perniit 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 whe[her or not specitied herein.This permit will <br /> expire and become null and void if cons[ruction 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 afrer work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with the S[ate Building Code.This permit may be <br /> revoked at any time for due cause. � <br /> / / (� / / <br /> Applicant Permitee Signature DatP Issued By Sign ture Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />