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� '� CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 2 - PJ 0 6 8 6 * <br /> DATE ISSUED: 07/18/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4051 H[GHWOOD RD <br /> PIN : 07-117-23-44-0076 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1420 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTG: THIS$700.00 LSCROW IS"I�IED TO IONING PERMIT#12-3568-C.U.P.AND VARIANCE <br /> APPLICANT <br /> ESCROW FEE-APPLICANT 700.00 <br /> ROUSE, WILLIAM&ANITA TOTAL 700.00 <br /> 4051 HIGHWOOD ROAD <br /> MOUND, MN 55364 <br /> OWNER <br /> ROUSE, WILLIAM & ANITA <br /> 4051 HIGHWOOD ROAD <br /> MOUND, MN 55364 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this perniit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This pemiit is for only the work described and does <br /> not grant permission Yor 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.'I his permit will <br /> expire and become null and void if construction authorized is no[ <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 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 Issued By Signature Date <br /> SEPARATE PERM[TS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />