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� � CITY OF ORONO * 2 0 1 5 - PJ 0 5 PJ 1 * <br /> ' 2750 KELLEY PARKWAY DATE ISSUED: 04/29/2015 <br /> ORONO,NIN 55356- <br /> 952 Z49-4600 FAX: 952 249-4616 <br /> ADDRESS : 3640 JACOBS MII.,L 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: TEIIS 52500 ESCROW IS T�D TO LAND USE APPLICATON 2015-00480 <br /> APPLICANT ESCROW FEE-APPLICANT 2,500.00 <br /> ESCROW FEE-DEVELOPER 0.00 <br /> HOFFMAN,KEITH&MARY <br /> 3640 JACOBS MII.,L RD TOTAL 2,500.00 <br /> LONG LAKE,MN 55356- Payment(s) <br /> CHECK 8495 2,500.00 <br /> � <br /> � Cit"y of drono <br /> � 2750 Ke11'ey Parkway <br /> Orono MN 55356 952-249-4600 <br /> OWNER Receipt No: 3.013254 Apr 24. 2015 <br /> HOFFMAN,KEITH&MARY , <br /> 3640 JACOBS MII,L RD ' 364u Jacobs Mi 11 Rd <br /> LONG LAKE,MN 55356- ' Previous Balance: .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,appticable City approvals,and the Deferred Rev-Developer Deposi t <br /> State Building Code. This permit is for only the work described and dces '-"---"""'- <br /> not gant peratission for addidonal or related work which requires sepazau � TOt21: 2,550.00 <br /> --------------- <br /> pemuts. All provisions of laws and ordinances goveming this type of work ------"'---"- <br /> shall be compied with whether or not specified herein.'This permit will Check , <br /> expire and become null and void if construction authoriud is not Pey�♦No: $495 2,550.00 <br /> commenced within 180 days of the date of issuance,or if wnstruction is 3640 Jacobs M i 11 Rd <br /> suspended for a period of 180 days at any time after work has commenced. To ta 1 App 1 i ed: 2,550.00 <br /> The applicant is responsible for assuring all required inspecdons are ' --------------- <br /> requested in confo�mance wi�h me Scace Building Code.This permic may be � Change Tendered: .00 � <br /> rovoked at any time for due cause. --°'-'-'O°-°- <br /> Duplicate Coey <br /> � 04/29/2015 07:35AM <br /> / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br />