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CITY OF ORONO 111 2 111111 I�I3 Ill I�I h I II II <br /> 2750 KELLEY PARKWAY DATE ISSUED: 05/30/2017 <br /> ORONO, MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2040 WAYZATA BLVD W <br /> PIN : 34-118-23-21-0036 <br /> LEGAL DESC : ORONO AMBAR <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: THIS$5000 ESCROW IS TIED TO THE NON LAND USE APPLICATION FOR ORONO SENIOR HOUSING PAID BY VOLUNTEERS <br /> OF AMERICAN <br /> APPLICANT ESCROW FEE-APPLICANT 5,000.00 <br /> TOTAL 5,000.00 <br /> Orono Housing&Redevelop Authority Payment(s) <br /> 2750 KELLEY PKWY <br /> CHECK 511161 5,000.00 <br /> CRYSTAL BAY,MN 55356- <br /> OWNER <br /> Orono Housing&Redevelop Authority <br /> 2750 KELLEY PKWY <br /> CRYSTAL BAY,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 />