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� CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 3 — 0 1 2 4 1 * <br /> DATE ISSUED: 1U25/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1645 BOHNS POINT RD � <br /> PIN : 17-117-23-11-0007 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0565 <br /> : LOT 000 BLOCK 000 Cit of Oror�a <br /> 27�� Kelley Parkway <br /> PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT pY,a� p� �53� y5�_�49_4b00 <br /> PROPERTY TYPE : RESIDENTIAL Receipt Na: s.41Q128 Nav �5! �U13 <br /> CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> Jahn E Klerissa Church <br /> NOTE: TIED TO BUILDING PERMIT 2013-01028 <br /> Plannin and Zoning <br /> 2413-U1�41 ib45 bohr� Pt 2,5bG,�1 <br /> Rd <br /> 101-2?.�US <br /> Deferred kev-Develaper Depr,sit <br /> T�tal: � �z�,�jp <br /> Check �-� _ <br /> Check No: 4456 �,gpp,pp <br /> Payor: <br /> John & Klerissa Chur�ch <br /> Total Applied: �,�pp.pp <br /> Char�ge Tendered: ,(� <br /> lllc�'S/2U13 11:52AM �� <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> CHURCH,JOHN&KLERISSA TOTAL 2,500.00 <br /> 1645 BOHNS PT RD <br /> WAYZATA,MN 55391- <br /> OWNER <br /> CHURCH, JOHN&KLERISSA <br /> 1645 BOHNS PT RD <br /> WAYZATA,MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shal]be performed according to <br /> ffie 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 nul]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 /> / / / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />