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� ___ _ <br /> � <br /> ! CITY OF ORONO PERMIT NO.: 2011-00031 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE IssuEn: OU13/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3095 NORTH SHORE DR <br /> 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: <br /> THIS ESCROW PAYMENT OF$2500.00 IS TIED TO BUILDWG PERMIT#2011-00005 PAID WITH CHECK#7198 <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> SIME, MICHAEL&PAMELA TOTAL 2,500.00 <br /> 1592 MEDINA 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 wark Y'or which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> � S[ate 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 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 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 /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />