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_ _ . CITY OF ORONO * 2 0 1 5 - 0 B 2 9 0 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 03/10/2015 <br /> ORONO,MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 4195 HIGHWOOD RD <br /> PIN : 07-117-23-44-0095 <br /> LEGAL DESC : HIGHWOOD LAKE MTKA <br /> : LOT MB BLOCK MB <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: THIS$700 ESCROW IS TIED TO ZONING APPLICATION 15-3725 <br /> APPLICANT ESCROW FEE-APPLICANT 700.00 <br /> ESCROW FEE-DEVELOPER 0.00 <br /> SMITH,DOUGLAS&ROBAN TOTAL 700.00 <br /> 4195 HIGHWOOD RD Payment(s) <br /> MOUND,MN 55364- CHECK 2415 700.00 <br /> OWNER <br /> SMITH,DOUGLAS&ROBAN <br /> 4195 HIGHWOOD RD <br /> MOLJND,MN 55364- <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 only the work described and dces <br /> not grant permission for additional or related work which requires sepazate <br /> permits. All provisions of laws and ordinances goveming 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 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 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 />