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CITY OF ORONO * z 0 1 4 - 0 1 z 0� <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/15/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1420 SHORELINE DR <br /> PIN : 11-117-23-22-0015 <br /> LEGAL DESC : DRAGONFLY HILL <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ 128,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$128000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: ADITION <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2014-01201 <br /> APPLICANT ADVANCED PLAN REVIEW 796.09 <br /> JANETKA CONSTRUCTION CONSULTANTS TOTAL 796.09 <br /> Payment(s) <br /> 3505 COUNTY ROAD 19 CHECK 6325 796.09 <br /> MEDINA, MN 55340- <br /> (612)418-6708 <br /> Minnesota State License#: BUIL-BC639945 <br /> OWNER <br /> FELDSHON,DAVID&ARCHELLE <br /> 1420 SHORELINE DR <br /> WAYZATA, MN 55391- <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 gran[permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances goveming this rype 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> � /Dl /� l� <br /> Applicant Permitee Signature Date Issu By Signature Date <br />