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CITY OF ORONO * 2 0 1 2 - 0 0 7 5 4 * <br /> � � 2750 KELLEY PARKWAY DATE ISSUED: 08/03/2012 <br /> �. ORONO, MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 2515 KELLY AVE <br /> PIN : 20-117-23-12-0038 <br /> LEGAL DESC : REG.LAND SURVEY NO. 1428 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> VALUATION : $ 95,575.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$95,575.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: REPLACE DECKING,INSTALL FIREPLACE,CONCRETE&WINDOWS <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2012-00'f� 7 5(P <br /> APPLICANT ADVANCED PLAN REVIEW 667.39 <br /> MOM'S LANDSCAPING&DESIGN TOTAL 667.39 <br /> 12276 JOHNSON MEMORIAL DRIVE <br /> SHAKOPEE,MN 55379- PAID WITH CC# _ 6431 <br /> (952)277-6667 <br /> Minnesota State License#:BC638384 <br /> OWNER <br /> HARDTEN,DAVID&CHRISTINE <br /> 2515 KELLY AVE <br /> EXCELSIOR,MN 55331- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This permit is for only the work described and dces <br /> not grant pertnission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances goveming this type 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 aze <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 Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />