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: - CITY OF ORONO * z 0 1 5 — r� 1 5 8 1 * <br /> . 2750 KELLEY PARKWAY DATE ISSUED: 12/18/2015 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1629 BOHNS POINT RD <br /> PIN : 17-117-23-11-0005 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0565 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: ESCROW TIED TO ZONING PERMIT#2015-01579-PAID BY:OWNER,CAROLINE AMPLATZ-CK#5044-$2,500.00 <br /> NOTE:MELANIE HAD ME ENTER THIS PAYMENT FOR ESCROW. AS OF 12/18/15 THE ESCROW AGREEMENT HAS NOT BEEN <br /> DROPPED OFF YET. <br /> APPLICA1vT ESCROW FEE-APPLICANT 2,500.00 <br /> TOTAL 2,500.00 <br /> AMPLATZ,CAROLINE Payment(s) <br /> 345 LEAF ST CHECK 5044 2,500.00 <br /> P.O.BOX 619 <br /> WAYZATA,MN 55391- <br /> OWNER <br /> AMPLATZ, CAROLINE <br /> 345 LEAF ST <br /> P.O.BOX 619 <br /> WAYZATA,MN 55391- <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 sepazate <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 /> i � c� �`+ � n ��--s�`I-�� � � Z� I� � l S <br /> Applicant Permitee Signature Date Issued By Sign re Date <br />