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� w CITY OF ORONO PERMIT NO.: 2011-00099 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE iSSUEu: 02/15/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 120 CREEK RIDGE PASS <br /> �� PIIY : 03-i l 7-23-12-0014 <br /> LEGAL UESC : CREEKSIDE 1N ORONO <br /> : LOT 003 BLOCK 001 <br /> � PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 385,000.00 <br /> NOTE: PLLASE FILI,IN THE FOI,LOWING: <br /> VALUATION OP YLRMIT: $ 385000.00 <br /> TYPG OP PERMIT'I`HIS PAYMENT IS 1 OR: NEW 1IOMG <br /> PGRMIT#TI��IS NRF,-PAYMENT IS 1'ILD TO:201 1-00100 <br /> APPLICANT ADVANCED PLAN REVIEW 1,798.39 <br /> RICHARD J. ELSEN CONSTRUCTION INC. TOTAL 1,798.39 <br /> I 1317 TOLEDO AVE. N. <br /> CHAMPLIN, MN 55316- <br /> (612)759-2826 <br /> Minnesota State License#: 4510 <br /> OWNER c'riU flu)i� <br /> Cr��,r�o +t�s. ,__,._ .... _,. <br /> GUSTAFSON, MICHAEL& SUSAN � <br /> 1000 SHELARD PKWY #300 �.�tJi�t �"t`: �.4�'���� " � ' <br /> MINNEAPOLIS, MN 55426- - _ , <br /> AGREEMENT AND SWORN STATEMENT <br /> I'he�o�ork for���hich this permit is issued shall bc performed according to r= �'=��� <br /> the approved plans and specifications,applicable City approvals,and Uie ��1 ��� <br /> State[3uilding Code. T'his pemiit is for only the�vork described and does ���r� = <br /> not grant permission for additional or related work�vhich requires separate .����� �� .-- <br /> permits. All provisions of laws and ordinances governing this type of work �'� <br /> � shall be compied with�vhether or not specilied herein.This permit�vill � �� <br /> :.,'::r•i.'k <br /> expire and become null and void ii�construction authorized is not � t;,� � •r•.:,_ <br /> .,.e,k Nc�: i::,74� 1,� , <br /> commenced within 180 days ot�the date oYissuance,or it�construction is ;^����:� <br /> suspended for a period of 180 days at any time atter�vork has commenced. �•-:�g�+;-j j [Je�ri �pp�,�;�u�U lC�!'r <br /> l he applicant is responsible for assuring all required inspections are �j�,�'i�:,� � 7 <br /> requcsted in confo nance witl B£at�f3uilding Code.This permit may be � <br /> revoked at�t�n, ',r du��c�x( <br /> I , �-�' <br /> � �_= - � �/S � // / / <br /> plicant Perimit�e Signature Uate Issued By S' ature Date <br /> ' SEPARATE PERMITS RGQU[RED FOR WORK OTHER THAN DESCRIBED ABOU . <br />