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CITY OF ORONO * z 0 1 3 — fd 0 3 8 7 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 05/2]/2013 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4395 NORTH SHORE DR <br /> PIN : 07-117-23-43-0018 <br /> LEGAL DESC : SAGA HILL REVISED <br /> : LOT 000 BLOCK 018 <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 2013-00317-PD BY LECY BROS-CHECK#35573 <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> LECY BROS HOMES ESCROW FEE-EROSION CONTROL 0.00 <br /> 15012 HWY 7 ESCROW FEE-GRADING 0.00 <br /> MINNETONKA,MN 55345 <br /> (952)944-9499 TOTAL 2,500.00 <br /> Minnesota State License#:20325555 <br /> OWNER <br /> WARDEN,MR.&MRS.KENT <br /> 4395 NORTH SHORE DR <br /> MOUND,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 separale <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. <br /> / / / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />