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, . CITY OF ORONO * Z 0 1 3 - 0 1 3 2 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 12/30/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 565 LEAF ST <br /> PIN : OS-117-23-41-0028 <br /> LEGAL DESC : FOX HOLLOW <br /> : LOT 003 BLOCK 001 <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 143648 <br /> APPLICANT ESCROW FEE-APPLICANT 700.00 <br /> ESCROW FEE-DEVELOPER 0.00 <br /> GOODWIN, BEN &HEATHER TOTAL 700.00 <br /> 565 LEAF ST <br /> LONG LAKE, MN 55356- Payment(s) <br /> CHECK 1681 700.00 <br /> OWNER <br /> GOODWIN, BEN&HEATHER <br /> 565 LEAF ST <br /> LONG LAKE,MN 55356- <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 does <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of Iaws 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 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 afrer 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 />