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CITY OF ORONO * z 0 1 3 - B 1 1 3 3 * 2750 KELLEY PARKWAY DATE ISSUED: 10/24/2013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2775 COUNTRYSIDE DR W PIN : 04-117-23-12-0016 LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN : LOT 001 BLOCK 003 PERMIT TYPE : ADVANCED PLAN REVIEW PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADVANCED PLAN REVIEW VALUATION : $ 150,000.00 NOTE: PLEASE FILL IN THE FOLLOWING: VALUATION OF PERMIT: $ 150,000.00 TYPE OF PERMIT THIS PAYMENT IS FOR: 2013-01 134 YERM[T#'I'HIS PRE-PAYMF,NT IS TIED TO:ADDITION APPLICANT ADVANCED PLAN REVIEW 881.89 SHORELINE BUILDERS TOTAL 881.89 2184 SHADYWOOD RD WAYZATA, MN 55391- (763)506-0629 Minnesota State License#: BC630814 OWNER MURLEY, TODD& MARY 2755 COUNTRYSIDE DR W LONG LAKE, MN 55356 AGREEMENT AND SWORN STATEMENT The work 1�or which this pcnnit is issued shall be perrormed according to the approvcd plans and speciYications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whe[her or not specified herein.This permit will expim and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time afrer work has commenced. The applicant is responsible for assuring all required inspections are requested in confom�ance with the State Building Code.This permit may be � revoked at any time for due cause. / / f� /� // Applicant Permitee Signature Date ssued �Signature Date SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED ABOVE.