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� � <br /> . CITY OF ORONO * 2 0 1 5 - 0 1 5 6 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 12/16/2015 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3188 NORTH SHORE DR <br /> PIN : 09-117-23-32-0011 <br /> LEGAL DESC : CRYSTAL BAY PARK <br /> : L01' 000 BLOCK 004 <br /> PERMIT TYPE : ESCKOW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: THIS$2500 ESCROW IS TIED TO ZONING PERMIT 16-3798 <br /> APPLICANT ESCROW FEE-APPLICANT 2,500.00 <br /> RUCINSKI,MICHEAL&HOLLY TOTAL 2,500.00 <br /> 3188 NORTH SHORE DR payment(s) <br /> WAYZATA,MN 55391- CHECK 5035 2,500.00 <br /> OWNER <br /> RUCINSKI,MICHEAL&HOLLY <br /> 3188 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 does <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of Iaws and ordinances goveming this rype of work <br /> shall be compied with whether or not specified hereia 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 alter work has commenced. <br /> The applicant is responsible for assuring all requlred inspections are <br /> requested in conformance with the State Building Code.Thie permit may be <br /> revoked at any time for due cause. <br /> / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br />