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CITY OF ORONO * 2 0 1 z - 0 0 1 7 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 03/2U2012 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 763 BOULDER DR <br /> PIN : 33-118-23-11-0004 <br /> LEGAL DESC : STONEBAY <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : ADVANCED PLAN REV[EW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 120,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 120,000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: BUILDING PERMIT <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2012--00176 <br /> APPLICANT ADVANCED PLAN REVIEW 764.89 <br /> STONE BAY CONSTRUCTION TOTAL 764.89 <br /> 14194 GLEN LAKE DWVE <br /> MINNETONKA,MN 55345- <br /> (952)240-9468 <br /> Minnesota State License#: 206385261 <br /> OWNER <br /> O.T. Development, LLC <br /> ZACHMAN,ARNIE <br /> 14196 GLEN LAKE DRNE <br /> M[NNETONKA, MN 55345- <br /> AGREEMEIVT AND SWORIV STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specitications,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 whe[her 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 /> 'l he 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 /> � l ��/l2GC�/ vl �ll / <br /> Applicant Permitee Signature Date Is e By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />