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� � � � MIDWESTONE BANK ��0�� <br /> 72-123f139 <br /> 6117 Slus Circle Drive, S�ite 101 <br /> WOOD�ALE Minnetonka,MN 55343 <br /> e „ � � D E R s �952�345-0543-(952).345-0544 <br /> Pay: *******�*****************Seven thousand five hundred dollars and no cents <br /> DATE � � CHECK NO. AMOUNT <br /> May 31, 2016 85085 $******7, 500 . 00 <br /> PAY <br /> TO THE City of Orono � <br /> OflDER PO Box 66 � <br /> oF Crystal Bay, MN 55323-0066 <br /> .___ __ ___._..�_ _. . . � <br /> _.- _::_-,�.- .-_ <br /> ,_ .__ .._ __, -._.�-s�.��_.-� City o Orono <br /> ___.__.__. <br /> �W r�;r;-tsuiLlii: 2750 Kelley Parkway <br /> �:_-�--_- -- Orono MN 55356 952-249-4600 <br /> WOODDALE BUI snt(s) <br /> 6117BLUECRDF -- -�— --`-- ` Receipt No: 3.015700 Jun 1, 2016 <br /> : _ --_.�: K 8508_ <br /> < <br /> MINNETONKA,MN 55343- <br /> (952)345-0543 <br /> Minnesota State License#:BUIL-BC002926 Wooddale Bui lders <br /> Planning and Zoning <br /> OWNER 2016-00620 3375 Graham 7,500.00 <br /> Hill Rd <br /> Wooddale Builders 101-22205 <br /> 6117 BLUE CIRCLE DR,STE 101 Deferred Rev-Developer Deposit <br /> --------------- <br /> MINNETONKA,MN 55343- <br /> Total: 7,500.00 <br /> --------------- <br /> --------------- <br /> Check <br /> AGREEMENT AND SWORN STATEMENT Check No: 85085 7,500.00 <br /> Payor: <br /> The work for which this permit is issued shall be performed according to Wooddale Bui lders <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This permit is for only the work described and dces Total Appl ied: 7,500.00 <br /> not grant permission for additional or related work which requires sepazate -----'--------- <br /> permits. All provisions of laws and ordinances governing this type of work Change Tendered: .00 <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 06/O 1/2016 08:48AM <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 commeoced. <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 /> Applicant Permitee Signature Date Issued By Signature <br />