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� . <br /> � CITY OF ORONO PERMIT NO.: 2011-01095 <br /> 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE ISSUED: 09/2U2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 4205 NORTH SHORE DR <br /> PIN : 07-117-23-43-0004 <br /> LEGAL DESC c ORCHARD BEACH <br /> : LOT 002 BLOCK 000 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: THIS$2500 ESCROW IS TIED TO ZONING APPLICATION I 1-3528 <br /> APPLICANT ESCROW FEE-APPLICANT 2,500.00 <br /> KOEHLER,TIMOTHY&DANIELLE ESCROW FEE-DEVELOPER 0.00 <br /> 4205 NORTH SHORE DR TOTAL 2,500.00 <br /> MOLJND,MN 55364— <br /> OWNER <br /> KOEHLER,TIMOTHY&DANIELLE <br /> 4205 NORTH SHORE DR <br /> MOUND,MN 55364 <br /> AGREEMENT AND SWORN STATEMENT <br /> 1'he 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 autttorized is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of 1 SO days at any time after work has commenced. <br /> 1'he applicant is responsible for assuring all required inspections are <br /> requested in conformance with tF►e State Building Code.1'his 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 />