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CITY OF ORONO l f 1 III1HHI II III zI QI III <br /> 2750 KELLEY PARKWAY DATE ISSUED: 12/10/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2120 WAYZATA BLVD W <br /> PIN : 34-118-23-24-0001 <br /> LEGAL DESC : UNPLATTED 34 118 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 3,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT: $ $3000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: BUILDING PERMIT <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2013-01280 <br /> APPLICANT ADVANCED PLAN REVIEW 57.53 <br /> ERICKSON,BRAD TOTAL 57.53 <br /> Payment(s) <br /> 2486 BOBOLINK RD <br /> CHECK 8334 57.53 <br /> MEDINA, MN 55356- <br /> (612)490-2371 <br /> OWNER <br /> ERICKSON, BRAD <br /> 2486 BOBOLINK RD <br /> MEDINA,MN 55356- <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 /> 7...e.... , ,g,__, <br /> _ /p�/a <br /> Applicant Permitee Signature Da e Issued By gnature Date <br />