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r <br /> CITY OF ORONO * 2 0 1 6 - 0 P1 1 9 7 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 02/26/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4220 CHIPPEWA LA <br /> PIN : 31-118-23-42-0012 <br /> LEGAL DESC : CHIPPEWA 2ND ADDN <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> NOTE: THIS$2500 ESCROW IS TIED TO DEMOLITION PERMIT 2016-00196 <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> TOTAL 2,500.00 <br /> DBG,LLC Payment(s) <br /> 4725 WEST LANE CHECK 5068 2,500.00 <br /> MINNETRISTA,MN 55364- <br /> OWNER <br /> DBG,LLC <br /> 4725 WEST LANE <br /> MINNETRISTA,MN 55364- <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 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 afrer work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance wi[h 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 />