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1 � <br /> CITY OF ORONO * Z 0 1 3 - PJ 1 0 6 9 * <br /> ' " 2750 KELLEY PARKWAY DATE ISSUED: 03/19/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2650 COUNTRYSIDE DR W <br /> PIN : 04-117-23-]2-0014 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 006 BLOCK 002 <br /> PERMIT TYPE : ACCESSORY STRUCTURE <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCTION TYPE : POOL- IN GROUND <br /> ACTIViTY : 329-5"I'RUCTURES OTHER THAN BUILDINGS <br /> VALUATION : $ 31,500.00 <br /> NOTE: SEPARA7�E PERM[S REQUIRED: ELGCTRICAL(STATE) <br /> **ESCROW WILL BE REFUNDI�D AFTGR AS-BUILT SURVF,Y HAS BGGN SUBMITTF?D AND AYPROVED. INIT[AL:jI� <br /> APPLICANT PERMIT FEE SCHEDULE 488.25 <br /> STATE SURCHARGE(VALUATION) 15.75 <br /> PETERSON POOLS& SPAS INC. TOTAL 504.00 <br /> 131 10 EXCELSIOR BLVD Payment(s) <br /> MINNETONKA, MN 55343- CHECK 15798 504.00 <br /> (952)933-3010 <br /> OWNER <br /> JORGENSON, ROBERT <br /> 2650 COUNTRYSIDE 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 to <br /> the approved plans and specifications,applicablc City approvals,and Ihe <br /> State F3uilding Code. This permit is for only[he work described and does <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances goveming this type of work <br /> shall be compied with whether or not specified herein.'l�his pemiit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 1 SO days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time alter work has commenced. <br /> The applicant is responsible for assuring all rcquired inspections are <br /> requested in confonnance�vith the State Building Code.This permit may be <br /> revoked a anv time for due cause. <br /> � �/ � �� /�� <br /> pli nt Permitee gnatu • Date Issue y Si ture ate <br />