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' � �' CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 4 - 0 0 5 2 6 * <br /> DATE ISSUED: OS/29/2014 <br /> ORONO, MN 55356- <br /> 952) 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3860 NORTH SHORE DR <br /> PIN : 08-117-23-33-0095 <br /> LEGAL DESC : CRYSTAL BAY VIEW <br /> : LOT 000 BLOCK 007 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: THIS$2,000 ESCROW IS TIED TO ZONING PERMIT#201400517 <br /> APPLICANT ESCROW FEE-APPLICANT 2,000.00 <br /> ESCROW FEE-DEVELOPER 0.00 <br /> SIMMONS,BRETT TOTAL 2,000.00 <br /> 3860 NORTH SHORE DRIVE payment(s) <br /> MOtJND,MN 55364- CHECK 869 2,000.00 <br /> OWNER <br /> SIMMONS,BRETT <br /> 3860 NORTH SHORE DRIVE <br /> MOLJND,MN 55364- <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 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 aRer 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 />