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" � CITY OF ORONO PERMIT NO.: 2009-00431 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSVEn: 07/22/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3205 CRYSTAL BAY RD <br /> PIN : 17-117-23-41-0011 <br /> LEGAL DESC : TOWNSITE OF LANGDON PARK <br /> : LOT 001 BLOCK 002 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: <br /> THIS ESCROW PAYMENT IS ASSOCIATED WITH VARIANCE APPLICATION#09-3422. <br /> APPLICANT <br /> ESCROW FEE-APPLICANT 2,500.00 <br /> ANDERSON, RICHARD <br /> 3205 CRYSTAL BAY RD TOTAL 2,500.00 <br /> WAYZATA, MN 55391 <br /> OWNER <br /> ANDERSON, RICHARD <br /> 3205 CRYSTAL BAY RD <br /> WAYZATA, MN 55391 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be perYormed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This permit is for onty 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 specitied 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 l 80 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 Qy Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />