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• • - � CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 2 - 0 1 1 6 2 * <br /> DATE ISSUED: 1 U13/2012 <br /> ORONO, M1Y 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 � <br /> ADDRESS : 2990 SUSSEX RD <br /> PIN : 04-117-23-31-0020 <br /> LEGAL DESC : FOX BEND <br /> : LOT 3 BLOCK 4 <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 PERMITS 2012-1052 AND 2012-01055 <br /> PAID WITH CHECK#1107 BY SUSAN KELLY ON 1 U13/2012 <br /> APPLICANT ESCROW FEE-BUILDING 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 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 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 />