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CITY OF ORONO * 2012 - 01260 *
2750 KELLEY PARKWAY DATE ISSUED: 12/19/2012
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 4725 NORTH SHORE DR
PIN : 07-117-23-32-0066
LEGAL DESC : BERGQUIST&WICKLUNDS PARK
LOT MB BLOCK 5
PERMIT TYPE ADVANCED PLAN REVIEW
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE : ADVANCED PLAN REVIEW
VALUATION : $ 6,000.00
NOTE: PLEASE FILL IN THE FOLLOWING:
VALUATION OF PERMIT:$ 6,000
TYPE OF PERMIT THIS PAYMENT IS FOR: DECK
PERMIT#THIS PRE-PAYMENT IS TIED TO:2012-01259
APPLICANT ADVANCED PLAN REVIEW 86.29
KATHERINE TAYLOR HOMES,INC. TOTAL 86.29
120 RAILWAY STREET W
PO BOX 35 PAID WITH CC# 2239
LORETTO,MN 55357
(763)479-0301
Minnesota State License#:4738
OWNER
ROEDEL,JOHN
4725 NORTH SHORE DRIVE
MOUND,MN 55364-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,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 whether or not specified herein.This permit will
expire 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 after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
119 1
Applicant Permitee Signature Date � ZIss By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.