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CITY OF ORONO * Z 0 1 3 - 0 0 3 0 7 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OS/02/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1105 FERNDALE RD W <br /> PIN : 02-117-23-43-0033 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0441 <br /> : LOT MB BLOCK MB <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 757,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 757000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: NEW S"CRUCTURE <br /> PERMI'1'#THIS PRE-PAYMENT IS"I�IED T0:2013-00308 <br /> APPLICANT ADVANCED PLAN REVIEW 3,082.14 <br /> LIND NELSON CONST INC. <br /> 3794 299TH AVE NW TOTAL 3,082.14 <br /> ISANTI, MN 55040 PAID WITH CC# 1955 <br /> (612)282-3006 <br /> Minnesota State License#: BC384640 <br /> OWNER <br /> TRUWIT, CHIP <br /> 1105 FERNDALE RD W <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according ro <br /> the approved plans and specifications,applicable City approvafs,and the <br /> State Building Code. This permit is for only the work described and does <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specified herein."I'his permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 days of the date ot�issuance,or if construction is <br /> suspended for a period of 180 days at any time afrer 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 at any time for due cause. <br /> / / / / <br /> Applicant Permitee Signature Uate Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />