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CITY OF ORONO * 2 PJ 1 3 - 0 1 0 6 B * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/10/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2650 COUNTRYSIDE DR W <br /> PIN : 04-ll 7-23-12-OO14 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 006 BLOCK 002 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 31,500.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 31,500.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: POOL PERMIT <br /> PERMIT#THIS PRE-PAYMENT IS TIED T0:2013-01069 <br /> APPLICANT ADVANCED PLAN REVIEW 317.36 <br /> PETERSON POOLS& SPAS INC. TOTAL 31736 <br /> 13]]0 EXCELSIOR BLVD <br /> MINNETONKA, MN 55343- <br /> (952)933-3010 <br /> OWNER <br /> JORGENSON, ROBERT <br /> 2650 COUNTRYSIDE DR W <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work Sor which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable Ciri 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 whether or not specified herein.This permit will <br /> expire and become null and void if construction 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 assurin�all required inspections are <br /> requested in con rmance with the State Building Code.This permit may be <br /> revoked at an� �me for due c <br /> �� //� / / <br /> A p nt Permit e Signature Date Issued By S' ature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED ABOVE <br />