HomeMy WebLinkAbout2016-00912 - advance plan review fee CITY OF ORONO * Z 0 1 6 - 0 0 9 1 2 *
2750 KELLEY PARKWAY DATE ISSUED: 08/02/2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2760 COUNTRYSIDE DR W
PIN : 04-117-23-12-0011
LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN
: LOT 003 BLOCK 002
PERM[T TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
ACTIVITY : 434-RESIDENTIAL
VALUATION : $ 25,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 25,000.00
TYPE OF PERMIT THIS PAYMENT[S FOR: ADDITION
PERMIT#TFIIS PRE-PAYMENT IS TIED TO:2016-000913
APPLICANT ADVANCED PLAN REVIEW 281.89
TOTAL 281.89
STERN,JON&MOLLY Payment(s)
2760 COUNTRYSIDE DR W CHECK 10366 281.89
LONG LAKE, MN 55356
OWNER
STERN,JON&MOLLY
2760 COUNTRYSIDE DR W
LONG LAKE, MN 55356
AGREEMENT AND SWORIv 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 governing 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 after 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.
/ /
Applicant Permitee Signature Date Issued By Signature Date