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CITY OF ORONO * Z 0 1 6 - 0 0 9 1 2 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 08/02/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2760 COUNTRYSIDE DR W <br /> PIN : 04-117-23-12-0011 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 003 BLOCK 002 <br /> PERM[T TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ 25,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 25,000.00 <br /> TYPE OF PERMIT THIS PAYMENT[S FOR: ADDITION <br /> PERMIT#TFIIS PRE-PAYMENT IS TIED TO:2016-000913 <br /> APPLICANT ADVANCED PLAN REVIEW 281.89 <br /> TOTAL 281.89 <br /> STERN,JON&MOLLY Payment(s) <br /> 2760 COUNTRYSIDE DR W CHECK 10366 281.89 <br /> LONG LAKE, MN 55356 <br /> OWNER <br /> STERN,JON&MOLLY <br /> 2760 COUNTRYSIDE DR W <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORIv 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 /> Applicant Permitee Signature Date Issued By Signature Date <br />