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, - CITY OF ORONO * z 0 1 6 - 0 1 5 0 8 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 12/OU2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4565 BAYS[DE RD <br /> PIN : 06-117-23-21-0010 <br /> LEGAL DESC : BAYS[DE BERRY FARM <br /> : LOT 2 BLOCK 1 <br /> PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> NOTE: '['HIS$700 ESCROW IS TIED TO BU[LD[NG PERM[T 2016-01497 <br /> APPLICANT ESCROW FEE-BUILDING 700.00 <br /> TOTAL 700.00 <br /> DOUBECK,TIM&MARY Payment(s) <br /> 4565 BAYSIDE RD CHECK 3805 700.00 <br /> MAPLE PLAIN, MN 55359- <br /> OWNER <br /> DOUBECK, TIM& MARY <br /> 4565 BAYS[DE RD <br /> MAPLE PLAIN, MN 55359- <br /> AGREEMENT AND SWORN STATEMENT <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 Building Code. This permit is for oniy the work described and docs <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws 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 l80 days of the date of issuance,or if construction is <br /> suspended for a period of l80 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 />