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CITY OF ORONO * 2 0 1 4 - 0 1 0 5 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/18/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS 1000 WILLOW DR S <br /> PIN : 10-117-23-21-0004 <br /> LEGAL DESC UNPLATTED 10 117 23 <br /> LOT 000 BLOCK 000 <br /> PERMIT TYPE ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE ADVANCED PLAN REVIEW <br /> VALUATION $ 340,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 340000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR:ADDITION <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2014-01060 <br /> APPLICANT ADVANCED PLAN REVIEW 1,622.89 <br /> HOMES BY LEGACY TOTAL 1,622.89 <br /> P O BOX 245 Payment(s) <br /> CHECK 5047 1,622.89 <br /> EXCELSIOR,MN 55331- <br /> (612)270-6214 <br /> Minnesota State License#: BUIL-BC667652 <br /> OWNER <br /> KLOMBIES,LINDSAY&ANNA <br /> 1000 WILLOW DR S <br /> WAYZATA,MN 55391 <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 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.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 /> Applicant Permitee Signature Date Issued By Signature Date <br />