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CITY OF ORONO PERMIT NO.: 2011-01498 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 12/OU2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> A DRESS : 3190 SUSSEX RD <br /> P : 04-117-23-32-0007 <br /> L GAL DESC : FOX BEND <br /> : LOT 001 BLOCK 001 <br /> P RMIT TYPE : ADVANCED PLAN REVIEW <br /> P OPERTY TYPE : RESIDENTIAL <br /> C NSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> V LUATION : $ 150,000.00 <br /> N E: PLEASE FILL IN THE FOLLOWING: <br /> V UATION OF PERMIT:$ 150000.00 <br /> TY E OF PERMIT THIS PAYMENT IS FOR: REMODEL <br /> PE IT#THIS PRE-PAYMENT IS TIED TO:2011-01499 <br /> APPLICANT ADVANCED PLAN REVIEW 881.89 <br /> M PETERSON DESIGN BUILD INC. TOTAL 881.89 <br /> 616 WOODALE AVE S <br /> ED A,MN 55424 PAID WITH CC# 0222 <br /> (952 925-9455 <br /> M' esota State License#:6704 <br /> OWNER <br /> KE Y,JOHN&MARY <br /> 3190 SUSSEX RD <br /> LON LAKE,MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The ork for which this permit is issued shall be performed according to <br /> the a roved plans and specifications,applicable Ciry approvals,and the <br /> State uilding Code. This permit is for only the work described and dces <br /> not gr t permission for additional or related work which requires separate <br /> pertni . All provisions of laws and ordinances governing this type of work <br /> shall e compied with whether or not specified herein.This permit will <br /> expire and become null and void if construction suthorized is not <br /> comm nced within 180 days of the date of issuance,or if construction is <br /> suspe ded for a period of 180 days at any time after work has commenced. <br /> The a plicant is responsible for assuring all required inspections are <br /> reques ed in conformance with the State Building Code.This permit may be <br /> revok at any time for due cause. <br /> / / / / <br /> Appli ant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />