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CITY OF ORONO * 2 0 1 5 — 0 1 3 6 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/22/2015 <br /> ' ORONO, MN 55356- <br /> � (952) 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2435 NORTH SHORE DR <br /> PIN : 09-117-23-44-0010 <br /> LEGAL DESC : SCOTCH PINE ADDN <br /> : LOT 003 BLOCK 001 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: ESCROW FOR DRIVEWAY PERMIT#2015-01356-PA[D BY:BACKYARD REFLECT[ONS-CK#24108-$2,500.00 <br /> APPLICANT ESCROW FEE-APPLICANT 2,500.00 <br /> TOTAL 2,500.00 <br /> HOUDE,ROBERT Payment(s) <br /> 2435 NORTH SHORE DR CHECK 24108 2,500.00 <br /> WAYZATA, MN 55391- <br /> OWNER <br /> HOUDE,ROBERT <br /> 2435 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 onty the work described and does <br /> not grant permission for additional or related work which requices 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 /> 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. fZ�;' <br /> ����'ZGI�� L� �l c, ���4 � o <br /> � �-/1 ����-I-S�.� �� z cZ �� <br /> Applicant Permitee Signature Date Issued By Signature Date <br />