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CITY OF ORONO *IIIZ 0 ill 71� _I I �5 6 11* <br /> 2750 KELLEY PARKWAY DATE ISSUED: 11/16/2017 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4160 FOREST LAKE DR <br /> PIN : 07-117-23-11-0003 <br /> LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN <br /> : LOT 004 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: INTERIOR REMODEL <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2017-01517 <br /> APPLICANT ADVANCED PLAN REVIEW 355.27 <br /> CLINE,JUSTIN&HOLLY TOTAL 355.27 <br /> Payment(s) <br /> 4160 FOREST LAKE DR CHECK 2486 355.27 <br /> MOUND,MN 55364- <br /> OWNER <br /> CLINE,JUSTIN&HOLLY <br /> 4160 FOREST LAKE DR <br /> MOUND,MN 55364- <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 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 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 /> • <br /> / —e &•r 7/ l Rel /7 <br /> Applicant Permitee Signature Date Issued By ature Date <br />