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� � CITY OF ORONO <br /> ` ` 2750 KELLEY PARKWAY * 2 0 1 5 - 0 0 5 0 1 * <br /> DATE ISSUED: 04/29/2015 <br /> ORONO,MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3640 JACOBS MILL RD <br /> PIN : 32-118-23-24-0010 <br /> LEGAL DESC : JACOBS MILL <br /> : LOT 004 BLOCK 001 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: THIS$2500 ESCROW IS TIED TO LAND USE APPLICATON 2015-00480 <br /> APPLICANT ESCROW FEE-APPLICANT 2,500.00 <br /> ESCROW FEE-DEVELOPER 0.00 <br /> HOFFMAN,KEITH&MARY TOTAL 2,500.00 <br /> 3640 JACOBS MILL RD Payment(s) <br /> LONG LAKE,MN 55356- CHECK 8495 2,500.00 <br /> � Lity ui urut�u <br /> �7`.�0 Kelley Par�kway <br /> Orur�u MN `�5356 55� �'4�a-46uii <br /> OWNER Receipt No: 3.013254 Apr 24, zUl� <br /> HOFFMAN,KEITH&MARY 3640 Jacobs Mi 11 Rd <br /> 3640 JACOBS MILL RD <br /> LONG LAKE,MN 55356- Previous Balanr,e: .00 <br /> Permits <br /> Zoning Permit 50.00 <br /> 101-32520 <br /> Zoning Permit <br /> AGREEMENT AND SWORN STATEMENT Permits <br /> Escrow 2,500.00 <br /> The work for which this permit is issued shall be performed according to 101-22205 <br /> the approved plans and specifications,applicable City approvals,and the Deferred kev-Deve loper Deposi t <br /> State Building Code. This permit is for only the work described and dces Tota 1: 2.550.00 <br /> not grant permission for additional or related work which requires separate _______________ <br /> permits. All provisions of laws and ordinances goveming this type of work Check <br /> shall be compied with whether or not specified herein.This permit will CF�eck No: 8495 2,550.00 <br /> expire and become null and void if construction authorized is not Payor: <br /> wmmenced within 180 days of the date of issuance,or if construction is 364U JaCobs M i 11 Rd <br /> suspended for a period of 180 days at any time after work has commenced. T o ta 1 App 11 ed: 2.55U.00 <br /> The applicant is responsible for assuring all required inspections aze ,ye T��r�drr ed: .iiU <br /> requested in conformance with the State Building Code.This permit may be ---- <br /> revoked at any time for due cause. �� <br /> (3Y�'te.e� /a-9 / <br /> Applicant Permitee Signature Date Issued By Signature Date <br />