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� _.., CITY OF ORONO * 2 0 1 4 - 0 0 7 9 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/29/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3515 SIXTH AVE N <br /> PIN : 29-118-23-43-0002 <br /> LEGAL DESC : UNPLATTED 29 118 23 <br /> : LOT 000 BLOCK 000 <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 ESCROW IS TIED TO BUILDING PERMIT 2014-00783 <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> ESCROW FEE-EROSION CONTROL 0.00 <br /> PETERSON,DALE&DIANE ESCROW FEE-GRADING 0.00 <br /> 3515 SIXTH AVE N TOTAL 2,500.00 <br /> LONG LAKE,MN 55356- <br /> Payment(s) <br /> CHECK 1748 2,500.00 <br /> OWNER <br /> PETERSON,DALE&DIANE , � <br /> 3515 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 permi[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 />