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CITY OF ORONO I'LI 20 1 3 - 00099 * <br /> 2750 KELLEY PARKWAY * DATE ISSUED: 02/12/2013 <br /> ORONO, MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 665 ORCHARD PARK RD <br /> PIN : 31-118-23-11-0005 <br /> LEGAL DESC : UNPLATTED 31 118 23 <br /> : LOT 000 BLOCK 000 • <br /> • <br /> PERMIT TYPE : ADVANCED PLAN REVIEW • <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ADVANCED PLAN REVIEW ' <br /> VALUATION : $ 450,000.00 Cityl f Orono <br /> NOTE: PLEASE FILL IN THE FOLLOWING: 250 Kelley Parkway <br /> • Orono 141 55356 -249- <br /> VALUATION OF PERMIT:$450,000 Receipt No: 3.008436 Feb 12, 2013 <br /> TYPE OF PERMIT THIS PAYMENT IS FOR: BUILDING PERMIT <br /> Systems Built Inc <br /> PERMIT#THIS PRE-PAYMENT IS TIED TO:2013-00100 Previous Balance: .00 <br /> Permits <br /> 2013-00099 665 Orchard 2,051.89 <br /> Park Rd <br /> 101-34410 <br /> Plan Check/Site Exam Fees <br /> Total: ----2,051.89 <br /> Check <br /> Check No: 2718 2,051.89 <br /> Payor: <br /> Systems Built Inc <br /> Total Applied: 2,051.89 <br /> APPLICANT ADVANCED PLAN REVIEW 2,051.89 <br /> SYSTEMS BUILT INC <br /> 5159 MAIN STREET TOTAL 2,051.89 <br /> MAPLE PLAIN,MN 55359- <br /> OWNER <br /> REYNOLDS,BILL <br /> 3630 LIVINGSTON AVE <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 /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />