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CITY OF ORONO * Z 0 1 7 - 0 0 3 3 4 * <br /> . 2750 KELLEY PARKWAY DATE ISSUED: 04/06/2017 <br /> � ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1700 SHORELINE DR <br /> PIN : 10-117-23-14-0022 <br /> LEGAL DESC : UNPLATTED 10 117 23 J <br /> : LOT 4 BLOCK 1 �_7�i,�'� -+r <br /> PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT J <br /> PROPERTY TYPE : RESIDENT[AL J�;�(��_�/I i �I��- <br /> CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> NOTE: ESCROW FOR BU[LDING PERMIT#2017-00332-PAID BY: HNH HOMES INC-$2,500.00 CK#9126 <br /> APPLICAIYT ESCROW FEE-BUILDING 2,500.00 <br /> TOTAL 2,500.00 <br /> HNH HOMES Payment(s) <br /> 13911 RIDGEDALE DRIVE#406D CHECK 9126 2,500.00 <br /> MINNETONKA, MN 55345- <br /> (952)288-3746 <br /> Minnesota State License#: BUIL-654037 <br /> OWNER <br /> 1RWIN JACOBS REV TRUST <br /> 1700 SHORELINE DR <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 afrer 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 f e se. , � <br /> , , � <br /> - �� / / '�- �' � �� /�� C ' ' � / ^ / <br /> Applicant Per � ee ignatdre Date Issued By Signature � Date <br />