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� �• � ITY F R � <br /> C O O ONO * z014 - 01066 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/19/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4460 FOREST LAKE LANDING <br /> PIN : 07-117-23-24-0015 <br /> LEGAL DESC : TONKAVIEW GARDENS <br /> : LOT O10 BLOCK 000 <br /> PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> NOTE: THIS$2500 ESCROW IS TIED TO F3liILDING PEItMIT 2014-00932 <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> ESCROW FEE-EROSION CONTROL 0.00 <br /> LEE'S LANDSCAPING &DESIGN ESCROW FEE-GRADING 0.00 <br /> 7990 69TH AVE N TOTAL 2,500.00 <br /> ROCKFORD,MN 55373- <br /> (763)688-1217 Payment(s) <br /> Minnesota State License#: BUIL-BC665790 CHECK 1566 2,500.00 <br /> OWNER <br /> BARTA, PATOM&JANICE <br /> 4460 FOREST LAKE LANDING <br /> MOLTND, MN 55364- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be perfomied 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 Iaws and ordinances governing 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.This permit may be <br /> revoked at any time for due cause. <br /> / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br />