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� �- CITY OF ORONO PERMIT NO.: 2oii-o�s�3 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �A'rE ISSUEn: 12/20/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 805 FOREST ARMS LA <br /> PIN : 07-117-23-12-0009 <br /> LEGAL DESC : FOREST ARMS <br /> : LOT 001 BLOCK 002 <br /> PERMIT TYPE : ESCROW FEE-WETLAND <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE- WETLAND <br /> NOTE: THIS$3000 ESCROW IS TIED TO PERMIT#2011-01475 FOR WETLAND BUFFER. <br /> APPLICANT ESCROW FEE- WETLAND 3,000.00 <br /> GURALMK, ALBERT& VALERIE TOTAL 3,000.00 <br /> 805 FOREST ARMS LA <br /> MOLIND, MN 55364- <br /> OWNER <br /> GURALNIK,ALBERT& VALERIE <br /> 805 FOREST ARMS LA <br /> MOUND, MN 55364- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is�ssued shall be performed according to <br /> tlie approved plans and specifica[ions,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 /> pennits. All provisions of laws and ordinances goveming 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 construc[ion authorized is not <br /> commenced within 180 days of the date of issuance,or if construc[ion 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 inspec[ions are <br /> requested in conformance with the Sta[e 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 />