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loll 1111111111 11111M <br /> CITY OF ORONO * 2012 - 00528 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/13/2012 <br /> ORONO,MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 4115 WATERTOWN RD <br /> PIN : 31-118-2341-0014 <br /> LEGAL DESC : MAPLE PLACE 2ND ADDN <br /> : LOT 002 BLOCK 001 <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 2012-00339-PD CHECK# 15804-MICHAEL DYER <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> DYER,MICHEAL&JILL TOTAL 2,500.00 <br /> 4115 WATERTOWN RD <br /> MAPLE PLAIN,MN 55359 <br /> OWNER <br /> DYER,MICHEAL&JILL <br /> 4115 WATERTOWN 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 Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />