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"'` `� CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 2 - PJ 0 5 1 6 * <br /> DATE ISSUED: 06/12/2012 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 2905 SIXTH AVE N <br /> PIN : 28-118-23-31-0006 <br /> LEGAL DESC : GARDEN GROVE <br /> : LOT 002 BLOCK 002 <br /> PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> NOTE: THIS$2500.00 ESCROW IS TIED TO BUILDING PERMIT#2012-00395 -PD BY JORGEN ELLINGSON-CHECK#1600 <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> ELLINGSON,JORGEN&YUMIKO TOTAL 2,500.00 <br /> 2905 SIXTH AVE N <br /> LONG LAKE,MN 55356- <br /> OWNER <br /> ELLINGSON,JORGEN&YUMIKO <br /> 2905 SIXTH AVE N <br /> LONG LAKE,MN 55356- <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 dces <br /> not grant permission for additional or related work which requires sepazate <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 /> / / / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />