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. CITY OF ORONO 1�11�1�1111111�11121111111111111101111�11111g1111�11111*II <br /> 27�0 KELLEY PARKWAY DATE ISSUED: 07/18/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> REYRINTED ON 7/18/2012 <br /> ADDRESS : 4051 HIGHWOOD 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 : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: THIS$700.00 ESCROV✓IS TIED TO ZONING PERMIT#12-3�68-C.U.P.AND VARIANCE <br /> APPLICANT 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 permit is issued shall be perfornied according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This pe�mit 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 wiil <br /> expire and become null and void if construciion 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 after work has commenced. <br /> The applican[is responsible for assuring all required inspections are <br /> requested in conformance with the Sta[e 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 PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />