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CITY OF ORONO * z 0 1 7 - a a 2 3 7 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 03/14/2017 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : � 1515 GREEN TREES RD <br /> PIN : 11-117-23-23-0013 <br /> LEGAL DESC : GREEN TREES ON TANAGER LAKE <br /> : LOT 003 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$2500 ESCROW IS TIED TO BUILDING PERMIT 2017-00206 <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> BURWELL TRUST,BARBARA TOTAL 2,500.00 <br /> Payment(s) <br /> 1100 MILLSTON ROAD CHECK 14613 2,500.00 <br /> WAYZATA,MN 55391- <br /> OWNER <br /> BURWELL TRUST,BARBARA <br /> 1100 MILLSTON ROAD <br /> WAYZATA,MN 55391- <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 goveming this rype of work <br /> shall be compied with whether or not speci6ed herein.This permit will <br /> expire and become null and void if construction suthorized is not <br /> commenced within l80 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 appiicant 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 />