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! <br /> _ ' CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 5 - 0 �1 1 1 7 * <br /> DATE ISSUED: OU23/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 4565 BAYSIDE RD <br /> PIN : 06-117-23-21-0010 <br /> LEGAL DESC : BAYSIDE BERRY FARM <br /> : LOT 2 BLOCK 1 <br /> PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> NOTE: ESCROW FOR NEW HOME PERMIT#2015-00115-PAID BY:DENALI CUSTOM HOMES CK#11273-$2,500.00 <br /> v���.ed- l �. <br /> `�, � � `��. <br /> '�.��_\ � V� <br /> �� ��� <br /> ��v <br /> S� <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> DENALI CUSTOM HOMES,INC. TOTAL 2,500.00 <br /> 18283 MINNETONKA BLVD. Payment(s) <br /> DEEPHAVEN,MN 55391- CHECK 11273 2,500.00 <br /> (952)476-2679 <br /> Minnesota State License#: BUIL-20175394 <br /> OWNER <br /> DOUBECK, TIM&MARY <br /> 4565 BAYSIDE 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 /> S[ate Building Code. This permit is for only the work described and does <br /> not grant permission for additional or related work which requires sepazate <br /> permits. All provisions of laws and ordinances goveming chis 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 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 /> ' �U� <br /> ' _ �1�-�-- UW�LCC.r� � ���J� /S <br /> Applicant Permitee S gna re Date Issued By Signature Date <br />