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CITY OF ORONO * 2 0 1 7 - 0 0 1 7 1 <br /> 2750 KELLEY PARKWAY DATE ISSUED: 02/22/2017 <br /> ORONO, MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS 1020 TONKAWA RD <br /> PITY 08-117-23-13-0014 <br /> LEGAL DESC REG. LAND SURVEY NO.0617 <br /> LOT 000 BLOCK 000 <br /> PERMIT TYPE ESCROW FEE-APPLICANT <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE ESCROW FEE-APPLICANT <br /> NOTE: THIS$2500 ESCROW IS TIED TO ZONING APPLICATION 17-3916 <br /> APPLICANT ESCROW FEE-APPLICANT 2,500.00 <br /> TOTAL 2,500.00 <br /> BURKE,FORREST Payment(s) <br /> 380 LEAF ST CHECK 4010 2,500.00 <br /> LONG LAKE,MN 55356- <br /> OWNER <br /> BURKE, FORREST <br /> 380 LEAF ST <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 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 /> Applicant Permitee Signature Date Issued By Signature Date <br />