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CITY OF ORONO * Z 0 1 6 - 0 1 3 4 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/24/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1885 CONCORDIA ST <br /> PIN : 17-117-23-23-0002 <br /> LEGAL DESC : COFFEES ADDN TO SHADY WOOD LAK <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 32,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUAT[ON OF PERMIT:$ 32,000.00 <br /> TYPE OF PERMIT THIS PAYMEN"C IS FOR: POOL PERMI"I' <br /> PERMI"I�#THIS PRE-PAYMF.NT IS TIF.D T02016-01350 <br /> APPLICANT ADVANCED PLAN REVIEW 333.26 <br /> PERFORMANCE POOL& SPA TOTAL 333.26 <br /> 2405 ANNAPOLIS Payment(s) <br /> CHECK 1554 333.26 <br /> PLYMOUTH, MN 55441- <br /> (763)270-1180 <br /> OWNER <br /> KAISER, BERNARD&CAROLYN <br /> 2855 PROVIDENCE PLACE <br /> INDEPENDENCE, MN 55359- <br /> AGREEMENT AND SWORN STATEMEIYT <br /> The work for which d�is perntit is issued shall be performed according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> State Quilding Code. This pennit is for only the work described and docs <br /> not grant permission for additional or related work�vhich requires separate <br /> permits. All provisions of laws and ordinances governing this rype of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become null and void if construction authorized is not <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 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 Date [ssued By Signature Date <br />