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` ' ' CITY OF ORONO PERMIT NO.: 2011-00613 <br /> 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE IssuEn: 07/1U2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1100 MILLSTON RD <br /> PIN : 10-117-23-14-0015 <br /> LEGAL DESC : MILLSTON <br /> : LOT 000 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$5,000.00 ESCROW IS TIED TO BUILDING PERMITR#20 1 1-004 1 2 <br /> APPLICANT ESCROW FEE-BUILDING 5,000.00 <br /> BURWELL,MR. &MRS.RODNEY P TOTAL 5,000.00 <br /> 7901 XERXES AVE S <br /> BLOOMINGTON,MN 55431- <br /> OWNER <br /> BURWELL,MR.&MRS.RODNEY P <br /> 7901 XERXES AVE S <br /> BLOOMINGTON,MN 55431- <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 sepazate <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 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 after work has commenced. <br /> The applicant is responsible for assuring all required inspections aze <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 /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />