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CITY OF ORONO * 2 0 1 5 — 0 1 1 7 6 * <br /> "" 2750 KELLEY PARKWAY DATE ISSUED: 09/15/2015 <br /> � ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1825 CONCORDIA ST <br /> p�� : 17-117-23-22-0015 <br /> LEGAL DESC : COFFEES ADDN TO SHADY WOOD LAK <br /> : LOT 008 BLOCK 000 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTIOIY TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 142,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 142,000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION/REMODGL <br /> PGRMIT#THIS PRE-PAYMENT IS TIED TO:20 1 5-0 1 1 75 <br /> APPLICANT ADVANCED PLAN REVIEW 893.22 <br /> TOTAL 893.22 <br /> LECY BROS HOMES Payment(s) <br /> 15012 HWY 7 CREDIT CARD 3171 893.22 <br /> MINNETONKA, MN 55345- <br /> (952)944-9499 <br /> Minnesota State License#: BUIL-20325555 <br /> OWNER <br /> WING,JOHN <br /> 1825 CONCORD[A ST <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 governing 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 construc[ion 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 /> ill ' <br /> ' C�/ ��� "� � �-�s:_-( `� �< <�,� �S� i <br /> (` <br /> Applicant Permitee Signature Date Issued By Signature Date <br />