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� CITY OF ORONO <br /> * 2016 - 00616 * <br /> , , 2750 KELLEY PARKWAY DATE ISSUED: 06/OU2016 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952 249-4616 <br /> ADDRESS : 2695 KELLY AVE <br /> PIN : 20-117-23-14-0008 <br /> LEGAL DESC : CARMAN COVE <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> NOTE: THIS$700 ESCROW IS TIED TO BUILDING PERMIT 2016-00491 <br /> APPLICANT ESCROW FEE-BUILDING 700.00 <br /> KIEPER,POLLY TOTAL 700.00 <br /> 2695 KELLY AVE Payment(s) <br /> EXCELSIOR,MN 55331- CHECK 12098 700.00 <br /> OWNER <br /> KIEPER,POLLY <br /> 2695 KELLY AVE <br /> EXCELSIOR,MN 55331- <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 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 will <br /> expire and become null and void if coastruction 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 /> 1'he applicant is responsible for assuring all requ'ved inspections are <br /> requested in conformance with the State Building Code.1'his permit may be <br /> revoked at any time for due cause. <br /> / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br />