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- � ' • � CITY OF ORONO PERMIT NO.: 20�1-01�6� <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DA'rE�SSUED: 09/30/2011 <br /> 952 249-4600 FAX: 9�2 249-4616 <br /> ADDRESS : 120 CREEK RIDGE PASS <br /> PIN : 03-117-23-12-0014 <br /> LEGAL DESC : CREEKSIDE IN ORONO <br /> : LOT 003 BLOCK 001 <br /> PERMIT TYPE : ESCROW FEE-OTHER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-OTHER <br /> NOTE: ESCROW FOR TEMPORARY CERTIFICATE OF OCCUPANCY BUILDING PERMIT 2011-00100 <br /> PAID BY MICHAEL&SUSAN GUSTAFSON- CHECK 133$1Q000.00 <br /> APPLICANT ESCROW FEE-OTHER 10,000.00 <br /> GUSTAFSON, MICHAEL& SUSAN TOTAL 10,000.00 <br /> 1000 SHELARD PKWY#300 <br /> MINNEAPOLIS,MN 5542Cr <br /> OWNER <br /> GUSTAFSON, MICHAEL& SUSAN <br /> ]000 SHELARD PKWY#300 <br /> MINNEAPOLIS, MN 55426- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permi[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 ordinances goveming 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 /> / / � � <br /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />