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CITY OF ORONO PERMIT NO.: 2011-01�73 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 553�6- DATE IssuEn: 12/20/2011 <br /> 952 249-4600 FA�: 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 : RESIDENTIAL <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 /> GURALNIK,ALBERT&VALERIE TOTAL 3,000.00 <br /> 805 FOREST ARMS LA <br /> MOLJND, MN 55364- <br /> OWNER <br /> GURALNIK, ALBERT& VALERIE <br /> 805 FOREST ARMS LA <br /> MOUND, MN 55364- <br /> AGREEMENT AND SWORN STATEMEI�'T <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 Buildin�Code. This permn is for only the work describeci and does <br /> not grant permission for additional or related work which requires sepazate <br /> permits. All provisions of laws and ordinances governing this type ofwork <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 1 SO davs 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 Buildin�Code.This permit may be <br /> revoked at any time for due cause. <br /> / / / / <br /> Applicant Permicee Signature Date lssued By�Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORIti OTHER THAN DESCRIBED ABOVE. <br />