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6 '� <br /> CITY OF ORONO * z 0 1 3 - 0 0 2 1 0 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 04/02/2013 <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-2013-00172-PD CHECK#110 <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> ELLINGSON,JORGEN&YUMIKO ESCROW FEE-EROSION CONTROL 0.00 <br /> 2905 SIXTH AVE N <br /> LONG LAKE,MN 55356- ESCROW FEE-GRADING 0.00 <br /> TOTAL 2,500.00 <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 does <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 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 />