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� _ <br /> CITY OF ORONO * 2 0 1 3 - 0 0 7 B 3 * <br /> 2750 KELLEY PARKWAY DATE ISSiJED: 08/12/2013 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2216 SHADYWOOD RD <br /> PIN : 17-117-23-42-0004 <br /> LEGAL DESC : WILEYS PARK LAKE MTKA <br /> : LOT O11 BLOCK 001 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: THIS$2500 ESCROW IS TIED TO ZONING APPLICATION 13-3627 AND BUILDING PERMIT 2013-00603,PAID BY CHECK# 1251 <br /> BY REBECCA SHABAZ. <br /> APPLICANT ESCROW FEE-APPLICANT 2,500.00 <br /> SHABAZ,REBECCA L ESCROW FEE-DEVELOPER 0.00 <br /> 2216 SHADYWOOD RD <br /> WAYZATA,MN 55391- TOTAL 2,500.00 <br /> OWNER <br /> SHABAZ,REBECCA L <br /> 2216 SHADYWOOD RD <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 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 />