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, CITY OF ORONO * z 0 1 2 - 0 0 8� <br /> 2750 KELLEY PARKWAY DATE ISSUED: 08/16/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1095 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 /> NOTE: THIS$2000.00 ESCROW IS'I'IED TO DEMOLITION PI�RMIT#2012-00766-PnID WITH CHGC�# 107�4 <br /> APPLICANT <br /> ESCROW FEE-APPLICANT 2,000.00 <br /> FOX, B 8 K TOTAL �,000.00 <br /> ]095 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 STATEMENT <br /> Thc work for which this permit is issued shall be performed accordin_�to <br /> the approved plans and specifications,applicable City approvals,and the <br /> Sta[e Building Code. This permit is for only the work described and does <br /> not grant permission for additional or related tiork which requires separate <br /> permits. All provisions of laws and ordinances governin�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 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 are <br /> requested in conformance with the State Building Code.7his permit may be <br /> revoked at am�time for due cause. <br /> / / ! / <br /> Applicant Permitee Siona�ure Date Issued B��Sienature Daic <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />