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, CITY OF ORONO * 2 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 BAYSIDE RD <br /> PIN : 06-117-23-21-0010 <br /> LEGAL DESC : BAYSIDE BERRY FARM <br /> : LOT 2 BLOCK 1 <br /> PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> NOTE: THIS$700 ESCROW IS TIED TO BUILDING PF,RM[T 2016-01497 <br /> APPLICANT ESCROW FEE-BUILDING 700.00 <br /> DOUBECK,TIM & MARY TOTAL 700.00 <br /> Payment(s) <br /> 4565 BAYSIDE RD CHECK 3805 700.00 <br /> MAPLE PLAIN, MN 55359- <br /> OWNER <br /> DOUBECK, TIM&MARY <br /> 4565 BAYSIDE RD <br /> MAPLE PLAIN, MN 55359- <br /> AGREEMENT AIYD SWORN STATEMENT <br /> Thc work for which this permit is issued shall be performed according to <br /> the approved pians 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 laws and ordinances governing this type of work <br /> shall be compied with whether or not specified herein.This permit�vill <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 1 AO days at any time atter 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 [ssued By Signature Date <br />