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CITY OF ORONO _ <br /> 2750 KELLEY PARKWAY * DANE ISSUED: 06/27/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952)249-4616 <br /> ADDRESS 125 TURNHAM RD <br /> PIN : 31-118-23-43-0018 <br /> LEGAL DESC UNPLATTED 31 118 23 <br /> LOT MB BLOCK MB <br /> PERMIT TYPE ESCROW FEE-APPLICANT <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE ESCROW FEE-APPLICANT <br /> NOTE: THIS$2,000 ESCROW IS TIED TO DEMOLITION PERMIT#2012-00590-PD BY MASTERPIECE HOMES-CHECK 39472 <br /> APPLICANT ESCROW FEE-APPLICANT 2,000.00 <br /> MASTERPIECE HOMES TOTAL 2,000.00 <br /> 127 EAST COUNTY RD C <br /> LITTLE CANADA,MN 55117- <br /> (651)484-3244 <br /> Minnesota State License#: 1435 <br /> OWNER <br /> ROCHEL,ANTHONY&SURYA <br /> 125 TURNHAM RD <br /> MAPLE PLAIN,MN 55359- <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 Perm ee Signature Date Issue Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />