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r � <br /> CITY OF ORONO PERMIT NO.: 2010-00260 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE IssuEn: 04/26/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> PRINTED WITHOUT ISSUING 5/11/2010 <br /> ADDRESS : 1795 SHADYWOOD RD <br /> PIN : 17-117-23-21-0008 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0702 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 15,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 15,000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: DECK ITION <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO: 2 0.00261 <br /> TOTAL AMOLINT OF$172.58 WILL BE REFUN D-JOB CANCELLED <br /> •✓`', <br /> APPLICANT ADVANCED PLAN REVIEW 172.58 <br /> BETZ BUILDERS INC. TOTAL 172.58 <br /> 300 CRESTVIEW AVE. <br /> LONG LAKE,MN 55356 <br /> (612)221-2963 <br /> OWNER <br /> DIERCKS, MICHAELA <br /> 1795 SHADYWOOD RD <br /> P.O. BOX 81(NAVARRE <br /> WAYZATA, MN <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 speciYied hecein.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 aIl 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 /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERM[TS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />