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CITY OF ORONO PERMIT NO.: 2oiaoiia3 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE IsstlEn: 1U19/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> REPRINTED ON 1/13/2011 <br /> � ADDRESS : 3095 NORTH SHORE DR <br /> i PIN : 09-117-23-32-0014 <br /> LEGAL DESC : REG.LAND SURVEY NO. 0670 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> NOTE: ESCROW OF$2,000 TIED TO DEMO PERMIT#2010-01141-PAID BY:OWNER,MICHAEL&PAMELA SIME VIA CK#7132 ON <br /> 11/19/10 <br /> APPLICANT ESCROW FEE-BUILDING 2,000.00 <br /> SIME, MICHAEL& PAMELA TOTAL 2,000.00 <br /> 1592 MED[NA RD <br /> LONG LAKE, MN 55356- <br /> OWNER <br /> ' SIME,MICHAEL&PAMELA <br /> 1592 MEDINA RD <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 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 /> � / / <br /> � ,Applicant Permitee Signature Date Issued By Signature Date <br /> � SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />