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CITY OF ORONO * z 0 1 5 - 0 0 7 7 7 * <br /> 2750 KELLEY PARKWAY DATE [SSUED: 06/16/2015 <br /> . � ORONO, MN 55356- <br /> 952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2655 COUNTRYSIDE DR W <br /> PIN : 04-117-23-13-0006 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 006 BLOCK 003 <br /> PERMIT TYPE : ADVANCED PLAN REV[EW <br /> PROPERTY TYPE : RESIDENT[AL <br /> COIYSTRUCTION TYPE : ADVANCED PLAN REV[EW <br /> VALUATION : $ 15,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT: $ I5,000.00 <br /> TYPE OF PERMIT THIS PAYMF,NT[S FOR: IN-GROUND POOL <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2015-00776 <br /> APPLICANT ADVANCED PLAN REV[EW 181.23 <br /> TOTAL 181.23 <br /> PERFORMANCE POOL& SPA Payment(s) <br /> 2405 ANNAPOLIS CHECK 1351 181.23 <br /> PLYMOUTH, MN 55441- <br /> (763)270-1180 <br /> Ci ty ��T Urona <br /> OWNER 275U Kelley Parkway <br /> Orono MN 55356 952-249-4600 <br /> VOSSEN, MICHAEL& KATHLEEN Receipt No: 3.013G28 Jun 16, �U15 <br /> 2655 COUNTRYSIDE DR W <br /> LONG LAKE, MN 55356- Performance Pool & Spa <br /> Frevious Balance: .00 <br /> Fermits <br /> 2015-0077i 1655 1ti1.23 <br /> AGREEMENT AND SWORN STATEMEIVT Countryside Di W <br /> The work for which this ermit is issued shall be erformed accordin to 101-34410 <br /> p p g Plar� Check/Site Fxam Fees <br /> the approved plans and specifications,applicable City approvals,and the ---..----- ------ <br /> State Buiiding Code. This permit is for only the work described and does Tot81: 181.�3 <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 Cheok <br /> shall be compied with whether or not specified herein.This permit will Check No: 1351 l Y 1.23 <br /> expire and become null and void if construction authorized is not Payor: <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 respo suring all required inspections are <br /> req ted in co €ortfiance t+tith the at�Building Code.This permit may be � <br /> re ok d at any time for d caus ' � , �' � <br /> , ; l � <br /> n �� n !� <br /> � <br /> ��, � ; � �,� i� �� � �,,� ���e�.'�� . ��� ° � ��- , / �, i� <br /> � <br /> icant Perm te igna e Date [ssued By Signature �l Date <br />