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� � • CITY OF ORONO * z 0 1 5 - 0 0 7 z a * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/08/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1]61 ELMWOOD AVE <br /> PIN - : 07-117-23-14-0029 <br /> LEGAL DESC : SKARP&LINDQUISTS FERNHILL LA <br /> : LOT 009 BLOCK 000 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: THIS$7500 ESCROW IS TIED TO BUILDING PERMIT-2013-01266 FOR TEMP CERTIFICATE OF OCCUPANCY <br /> .,;. • <br /> � <br /> APPLICANT ESCROW FEE-APPLICANT 7,500.00 <br /> ESCROW FEE-DEVELOPER 0.00 <br /> SUNDBERG,RICHARD <br /> 5125 WEST STREET TOTAL 7,500.00 <br /> GREENWOOD,MN 55331- Payment(s) <br /> CHECK 1313 7,500.00 <br /> City of Orono <br /> OWNER Oro�o eMNey55356Way 952-249-4600 <br /> SiJNDBERG,RICHARD Receipt No: 3.013571 Jun B, 2015 <br /> 5125 WEST STREET <br /> GREENWOOD,MN 55331- Richard Sundberg <br /> Previous Balance: .00 <br /> Permits <br /> Temp C.D. Escrow - 116 7,500.00 <br /> AGREEMENT AND SWORI�i STATEMENT Flmwood Ave <br /> 101-22205 <br /> The work for which this permit is issued shall be perfortned according to Deferred Rev-Developer Deposi t <br /> --------------- <br /> the approved plans and specifications,applicable City approvals,and the Total: 7,500.00 <br /> State Building Code. This permit is for only the work described and dces �_____�__�_____ <br /> not grant permission for additional or related work which requires sepazate Check <br /> permits. All provisions of laws and ordinances goveming this type of work CheCk N0: 1313 7,500.00 <br /> shall be compied with whether or not specified herein.This permit will Payor: <br /> expire and become null and void if construction authorized is not R i chard Sundberg <br /> commenced within 180 days of the date of issuance,or if construction is Total Appl led: 7,500.00 <br /> --------------- <br /> suspended for a period of 180 days at any time after work has commenced. Ch8flg0 Telldel'ed: .00 <br /> The applicant is responsible for assuring all required inspections are _______________ <br /> requested in confortnance with the State Building Code.This permit may be 06J08/2015 12:09PM <br /> revoked at any time for due cause. <br /> / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br />