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CITY OF ORONO PERMIT NO.: 2009-00517 <br /> 2750 KELLEY PARKWAY . <br /> ORONO, MN 55356- DATE IssuED: 08/24/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 980 FERNDALE RD W <br /> PIN : 02-ll 7-23-44-0019 <br /> LEGAL DESC : COUNTRY CLUB ESTATES <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDTNG PERMIT <br /> NOTE: ESCROW FEE FOR ADDITION/REMODEL PERMIT#2009-00496 <br /> 4 <br /> � <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> SAFAR,JACK&PAMELA <br /> 980 FERNDALE RD W TOTAL 2,500.00 <br /> WAYZATA,MN 55391- <br /> OWNER <br /> SAFAR,JACK&PAMELA <br /> 980 FERNDALE RD W <br /> WAYZATA,MN 55391- <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 Ciry 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 sepazate <br /> permiu. All provisions of laws and ordinances governing this type of work <br /> shal]be compied with whether or not specified herein.This permit wiil <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 aze <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 />