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� ` CITY OF ORONO <br /> 2750 KELLEY PARKWAY * z 0 1 2 — fd 0 1 4 9 * <br /> DATE ISSUED: 02/22/2012 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 780 BROWN RD N <br /> PIN : 34-118-23-11-0002 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1275 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPL[CA T <br /> NOTG: 12-3547 TONING APP <br /> �� <br /> � <br /> � <br /> APPL CANT ESCROW FEE-APPLICANT 2,500.00 <br /> STAVIG,JOHN& HOEBE <br /> 780 BROWN RD N TOTAL 2,500.00 <br /> LONG LAKE, MN 5 56- <br /> (612)625-2485 <br /> WN <br /> STAVIG,JOHN&PHOEB <br /> 780 BROWN RD N <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> Thc 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 ordinanecs 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 wi[hin 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 responsibie for assuring all required inspections are <br /> requested in conformance with the State Building Codc.This permit may be <br /> revoked at any time for due cause. <br /> / / / / <br /> Applicant Permitee Signature Uate Issued By Signalure Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />