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CITY OF ORONO <br />2750 KELLEY PARKWAY <br />ORONO, MN 55356- <br />11111111111111111 Ii 11111111111:1 I /Iii i 111 I'll 11!1 II 11111111 <br />*2015-00316* <br />DATE ISSUED: 03/18/2015 <br />(952) 249-4600 FAX: (952) 249-4616 <br />ADDRESS <br />PIN <br />LEGALDESC <br />: 4355 BAYSIDE RD <br />: 06-117-23-12-0007 <br />: UNPLA TTED 06 117 23 <br />: LOT 000 BLOCK 000 <br />PERMIT TYPE : ESCROW FEE -APPLICANT <br />PROPERTY TYPE : RESIDENTIAL <br />CONSTRUCTION TYPE : ESCROW FEE -APPLICANT <br />NOTE: THIS $2500 ESCROW IS TIED TO ZONING APPLICATION #15-3726 <br />APPLICANT <br />WHITE, GREG & LYNN <br />4355 BAYSIDE RD <br />MAPLE PLAIN, MN 55359- <br />OWNER <br />WHITE, GREG & LYNN <br />4355 BAYSIDE RD <br />MAPLE PLAIN, MN 55359- <br />AGREEMENT AND SWORN STATEMENT <br />The work for which this pennit is issued shall be perfonned according to <br />the approved plans and specifications, applicable City approvals, and the <br />State Building Code. This pennit is for only the work described and does <br />not grant pennission for additional or related work which requires separate <br />pennits. All provisions oflaws and ordinances governing this type of work <br />shall be compied with whether or not specified herein. This pennit will <br />expire and become null and void if construction authorized is not <br />commenced within 180 days of the date of issuance, or if construction is <br />suspended for a period of 180 days at any time after work has commenced. <br />The applicant is responsible for assuring all required inspections are <br />requested in confonnance with the State Building Code. This permit may be <br />revoked at any time for due cause. <br />Applicant Permitee Signature Date <br />ESCROW FEE -APPLICANT <br />ESCROW FEE -DEVELOPER <br />TOTAL <br />Payment(s) <br />CHECK 1313 <br />City of Orono <br />2750 Kelley Parkway <br />Orono MN 55356 <br />Receipt No: 3.012979 <br />952-249-4600 <br />Mar 18, 2015 <br />Greg & Lynn White <br />Planning and Zanin$ <br />15-3726 4355 Bayside Rd 700.00 101-34420 <br />Cond Use-Variance-Dev Fees <br />Planning and Zanin$ <br />15-3726 4355 Bayside Rd 2,500.00 101-22205 <br />Deferred Rev-Developer Deposit <br />---------------Total: 3,200.00 <br />Check <br />Check No: 1313 <br />Payor: <br />Greg & Lynn White <br />Total Applied: <br />Change Tendered: <br />-------·-----·--- <br />3,200.00 <br />3,200.00 <br />.00 <br />03/18/2015 10:02AM ---=- <br />Issued By Signature Date <br />I <br />2,500.00 <br />'o.oo <br />2,500.00 <br />2,500.00 <br />I