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CITY OF ORONO * 2 B 1 2 — P1 0 8 0 0 * <br /> c . '� 2750 KELLEY PARKWAY DATE ISSUED: 08/16/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : ]095 FERNDALE RD W <br /> PIN : 02-117-23-43-0023 <br /> LEGAL DESC : NORTH SHORE COTTAGE ACRES LAKE <br /> : LOT 009 BLOCK 000 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTG: THIS$2000.00 GSCROW IS TIED TO DEMOLITION PGRMIT#2012-00766-PAID WITH CHECK# 10754 <br /> APPLICANT ESCROW FEE-APPLICANT 2,000.00 <br /> FOX, B& K TOTAL 2,000.00 <br /> 1095 FERNDALE RD W <br /> WAYZATA, MN 55391- <br /> OWNER <br /> FOX, B& K <br /> 1095 FERNDALE RD W <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMEIVT <br /> 1'he work for which this permit is issued shall be perR�rmed according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> State[3uilding Code. '('his permit is for only the work described and does <br /> not grant permission for additional or rclatcd work which requires separate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whe[her or not specified herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within l80 days of the date of issuance,or if construction is <br /> suspended Yor 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 S[ate 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 />