HomeMy WebLinkAbout2013-01133 - adv plan review CITY OF ORONO * z 0 1 3 - B 1 1 3 3 *
2750 KELLEY PARKWAY DATE ISSUED: 10/24/2013
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2775 COUNTRYSIDE DR W
PIN : 04-117-23-12-0016
LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN
: LOT 001 BLOCK 003
PERMIT TYPE : ADVANCED PLAN REVIEW
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 150,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT: $ 150,000.00
TYPE OF PERMIT THIS PAYMENT IS FOR: 2013-01 134
YERM[T#'I'HIS PRE-PAYMF,NT IS TIED TO:ADDITION
APPLICANT ADVANCED PLAN REVIEW 881.89
SHORELINE BUILDERS TOTAL 881.89
2184 SHADYWOOD RD
WAYZATA, MN 55391-
(763)506-0629
Minnesota State License#: BC630814
OWNER
MURLEY, TODD& MARY
2755 COUNTRYSIDE DR W
LONG LAKE, MN 55356
AGREEMENT AND SWORN STATEMENT
The work 1�or which this pcnnit is issued shall be perrormed according to
the approvcd plans and speciYications,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 whe[her or not specified herein.This permit will
expim 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 afrer work has commenced.
The applicant is responsible for assuring all required inspections are
requested in confom�ance with the State Building Code.This permit may be �
revoked at any time for due cause.
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Applicant Permitee Signature Date ssued �Signature Date
SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED ABOVE.
DATA PRIVACY ADVISORY
In accordance with Minnesota State Statute 13.04 Rights of Subjects of Data, Subd. 2, "Tennessen
warning", we would like to inform you that your request for a permit or license from the City of Orono or
any of its departments may require you to furnish certain private or confidential information.
You are notified that:
1. The information you furnish will be used to determine your qualification for the permit or
license requested.
2. You may refuse to supply data, but refusal may require that the City deny the permit or
license.
3. The information may be shared with other Iocal, state or federal agencies to the extent
necessary to process the permit or license.
4. If your requested permit or license requires Council action to approve, some information
may become public.
5. You have certain rights under Minnesota State Statute 13.04 (see following page) to
review private data on yourself.
6. Your full name is required to process this application or permit.
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Signature ,
Packet Last Updated: 04/19/2013
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