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� CITY OF ORONO PERMIT NO.: 2011-01556 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE 1SSUED: 12/15/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1105 FERNDALE RD W <br /> PIN : 02-117-23-43-0033 <br /> LEGAL DESC : REG.LAND SURVEY NO. 0441 <br /> : LOT MB BLOCK MB <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: 7'HIS$2500 ESCROW IS TIED TO ZONING PERMIT APPLICATION 12-3540 <br /> APPLICANT ESCROW FEE-APPLICANT 2,500.00 <br /> BAGLEY, RALPH <br /> 602 CARTER ST TOTAL 2,500.00 <br /> GO GEORGE BAGLEY <br /> NEW CANAAN, CT 06840- <br /> OWNER <br /> BAGLEY,RALPH <br /> 602 CARTER ST <br /> C/O GEORGE BAGLEY <br /> NEW CANAAN,CT 06840- <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 wi[hin 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 />