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.� <br /> � CITY OF ORONO PERMIT NO.: 2o�ao�oos <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 10/14/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2990 SUSSEX RD <br /> PIN : 04-117-23-31-0014 <br /> LEGAL DESC : FOX BEND <br /> : LOT 003 BLOCK 003 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: THIS ESCROW PAYMENT OF$2500.00 WAS PAID FOR BY SUSAN KELLY ON 10/14/10 CHECK#245 <br /> AND IS CONNECTED TO ZONING APPLICATION#10-3489-LOT LINE REARRANGEMENT <br /> • <br /> APPLICANT ESCROW FEE-APPLICANT 2,500.00 <br /> KELLY,JUSTIN& SUSAN TOTAL 2,500.00 <br /> 2990 SUSSEX RD <br /> LONG LAKE,MN 55356 <br /> OWNER <br /> KELLY,JUSTIN&SUSAN <br /> 2990 SUSSEX RD <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 Ciry 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 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 />