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CITY OF ORONO * 2 0 1 4 - 0 0 0 6 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OU22/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 258 CYGNET PL <br /> PIN : 04-117-23-23-0019 <br /> LEGAL DESC : SWAN LAKE ADDN <br /> : LOT O10 BLOCK 003 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 6,400.00 <br /> NOTF,: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT: $ $6400.00 <br /> TYPE OF PERMIT T}IIS PAYMENT IS FOR: BUILDING PI;RMI"I' <br /> PERMIT#"I'HIS PRE-PAYMF.NT [S"I'I�D T0:2014-00064 <br /> APPLICANT ADVANCED PLAN REVIEW 95.88 <br /> TOTAL 95.88 <br /> DOUG LARSON CONSTRUCTION Payment(s) <br /> 16102 TEMPLE LANE CREDIT CARD 2064 95.88 <br /> MINNETONKA, MN 55345 <br /> �) <br /> Minnesota State License#: BUIL-BC06418 <br /> OWNER <br /> HUBBARD, ANNIE <br /> 258 CYGNET PL <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> I�he work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and thc <br /> State[3uilding 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.'I�his permi[will <br /> expire and become null and void if construc[ion authorired is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of l80 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 /> ��'�v��.�_ / / <br /> Applicant Per 't SignatUre Date Issued E3 S nature e <br />