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CITY OF ORONO * 2 0 1 5 - 0 1 2 2 7 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/22/2015 <br /> „ ORONO, MN 55356- <br /> � 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1380 BRIAR ST <br /> PIN : 10-117-23-31-0053 <br /> LEGAL DESC : MARKVILLE <br /> : LOT 000 BLOCK 002 <br /> PERMIT TYPE : ADVANCED PLAN REVIEW <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW <br /> ACTIVITY : 434-RESIDENTIAL <br /> VALUATION : $ 306,000.00 <br /> NOTE: PLEASE FILL IN THE FOLLOWING: <br /> VALUATION OF PERMIT:$ 306,000.00 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: NEW HOUSE <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:20 1 5-0 1 228 <br /> APPLICANT ADVANCED PLAN REVIEW 1,564.80 <br /> TOTAL 1,564.80 <br /> ZITZLOFF,JEFFREY& BRENDA Payment(s) <br /> 1380 BRIAR ST CHECK 9390 1,564.80 <br /> WAYZATA,MN 55391- <br /> Minnesota State License#: BUIL-BC20626592 <br /> �:L'�ii! Kr�l tP,�v �'dt�kway <br /> Urono MN 5�3�t� v�,�'-;'4�I 4i�ii�i <br /> Rec�ipt No: 3.014287 Sep z�, 2Ui:.� <br /> OWNER <br /> ZITZLOFF,JEFFREY&BRENDA Jeff Zitzloff <br /> 1380 BRIAR ST <br /> WAYZATA,MN 55391- Previous Balance: .pp <br /> Per�mi ts <br /> �015-0122? 138U Briar 1,564.�3U <br /> 5treet <br /> AGREEMENT AND SWORN STATEMENT 101--34410 <br /> The work for which this permit is issued shall be perfottned according to Plan Cheek/Si te Exam Fee5 <br /> the approved plans and specifications,applicable Ciry approvals,and the _______________ <br /> State Building Code. This permit is for only the work described and does TOta 1: <br /> not grant permission for additional or related work which requires separate 1.564.t�0 <br /> permits. All provisions of laws and ordinances goveming this type of work Cheek � ^ <br /> shall be compied with whe[her or not specified herein.This permit will <br /> expire and become null and void if construction authorized is not i;heCk N0: 9390 1,564.80 <br /> commenced within 180 days of the date of issuance,or if construction is Payor: <br /> suspended for a period of 180 days at any time afrer work has commenced. Jef f Z 1 tz 1 o f fi <br /> The applicant is cesponsible for assuring all required inspections are T��tai Appl led: <br /> requested in conformance with the State Building Code.This permit may be 1,564.8U <br /> revoked at any time for due cause. <br /> i,t�anre i�nde�ed� ,�;;; <br /> / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br />