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CITY OF ORONO * Z 0 1 5 - 0 0 9 0 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/20/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1120 COX FARM RD <br /> PIN : 27-118-23-31-0021 <br /> LEGAL DESC : SHADOWOOD FARM <br /> : LOT 005 BLOCK 001 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 35,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$35,000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: ADDITION <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2015-00902 <br /> APPLICANT ADVANCED PLAN REVIEW 355.26 <br /> TOTAL 355.26 <br /> TONY SCHREMPP CONSTRUCTION LLC payment(s) <br /> 1450 81ST STREET CHECK 355.26 <br /> VICTORIA, MN 55386- <br /> (952)443-2529 <br /> Minnesota State License#: BUIL-4357 <br /> OWNER <br /> WAGENER,GREGORY&LAURA <br /> 1120 COX FARM RD <br /> LONG LAKE, MN 55356- <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 reyuires sepazate <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 afrer work has commenced. <br /> The applicant is responsible for assuring all required inspections aze <br /> reques[ed in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br />