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► <br /> , ' � CITY OF ORONO PERMIT NO.: 2010-00138 <br /> � ' 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE �SSUEn: 03/12/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2650 COUNTRYSIDE DR W <br /> PIN : 04-117-23-12-0014 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 006 BLOCK 002 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 24,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT: $ 24000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: BLDG. PERMI"I' , <br /> PERMIT#THIS PRE-PAYMEN"I'1S'1'IED TO:2010-00139 � <br /> APPLICANT ADVANCED PLAN REVIEW 258.86 <br /> SPORT COURT OF MINNEAPOLIS <br /> 1301 E. CLIFF ROAD SUITE 104 iuT4?� ?58.86 <br /> BURNSVILLE, MN 55337- <br /> OWNER <br /> JORGENSON, ROBERT '`�G �'''����' <br /> 2650 COUNTRYS[DE DR W <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according[o :�f,'��y <br /> the approved plans and specifications,applicable City approvals,and the �r .:, <br /> r�rt.�i <br /> State Building Code. This permit is for only the work described and does �;t�ef;/,�;?1.?? G�wq! i <br /> not grant permission for additional or related work which requires separate <br /> permits. Ail provisions of laws and ordinances goveming this type of work �}� � <br /> shall be compied with whether or not speciYied herein.This permit will �__ `'i <br /> expire and become null and void if construction authorized is not --k <br /> commenced within 180 days of the date of issuance,or if construction is ;aa�,: : <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 a[any[ime for due cause. <br /> / / / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />