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CITY OF ORONO * 2 0 1 5 - 0 0 0 5 5 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OU20/2015 <br /> ORONO,MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3135 NORTH SHORE DR <br /> PIIv : 09-117-23-32-0018 <br /> LEGAL DESC : REG.LAND SURVEY NO. 1113 <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: THIS$2500 ESCROW IS TIED TO BUILDING PERMIT 2015-00054 <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> ESCROW FEE-EROSION CONTROL 0.00 <br /> REVOLUTION DESIGN BUILD ESCROW FEE-GRADING 0.00 <br /> 18110 MINNETONKA BLVD <br /> WAYZATA,MN 55391- TOTAL 2,500.00 <br /> (952)594-5037 Payment(s) <br /> Minnesota State License#:BUIL-BC631863 CHECK 7696 2,500.00 <br /> OWNER <br /> MARX,KELLY <br /> 3135 NORTH SHORE DR <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 type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expice and become null and void if construction suthorized is not <br /> commenced within I80 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 />