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' � � CITY OF ORONO PExMiT rto.: 2011-01091 <br /> 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE ISSUED: 09/20/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2690 RAINEY RD <br /> PIN : 04-117-23-43-0016 <br /> LEGAL DESC : TREES TO BE <br /> : LOT 003 BLOCK 002 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CO1wSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NO'IE: THIS$2500 ESCROW IS TIED TO ZONING APPLICATION 11-3527 <br /> APPLICANT ESCROW FEE-APPLICANT 2,500.00 <br /> SMITH,JASON&JODY TOTAL 2,500.00 <br /> 2690 RAINEY RD <br /> WAYZATA,MN 55391- <br /> OWNER <br /> SMITH,JASON&JODY <br /> 2690 RAINEY RD <br /> WAYZATA,MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed accotding to <br /> the approved plans and specifications,applicabie City approvals,and the <br /> State Building Code. This permit is for only the work described and does <br /> not gant permission for additional or related work which requires separate <br /> permits. All provisions of iaws and ordinances goveming this type of work <br /> shali be compied with whether or not specified herein.This permit will <br /> expii+e 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 aftel�work has commenced. <br /> The applicant is responsible for assuring all requirBd inspections aze <br /> requested in conformance with the State Building Code.This pern►it 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 />