2011-01295 - addn/remodel/repair

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CITY OF ORONO III III III 1 1 II IIII II III III I I I 11 1111111111111111 * 20 1 2 - 00E1313 * 2750 KELLEY PARKWAY DATE ISSUED: 08/24/2012 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 505 OLD CRYSTAL BAY RD S PIN : ' 04-117-23-31-0003 LEGAL DESC : AUDITOR'S SUBD.NO.230 : LOT 022 BLOCK 000 PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT NOTE: THIS$2500 ESCROW IS TIED TO BUILDING PERMIT#2012-001295-PD CHECK#3314 BY DAVID HARMANN APPLI(bANT ESCROW FEE-BUILDING 2,500.00 HARMANN, DAVID&MO4 ESCROW FEE-EROSION CONTROL 0.00 505 OLD CRYSTAL BAY RDI S LONG LAKE,MN 55356- ESCROW FEE-GRADING 0.00 TOTAL 2,500.00 OWNER HARMANN, DAVID&MONA 505 OLD CRYSTAL BAY Rd S LONG LAKE,MN 55356 11 - AGREEMENT AND SWORN STATEMENT The work fbr which this permit is issued shall be performed according to the approved plans and specification ,applicable City approvals,and the State Building Code. This permit is or only the work described and does not grant permission for additional o related work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be cotnpied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the d to of issuance,or if construction is suspended for a period of 180 days many time after work has commenced. The applicant is responsible for assn ing all required inspections are requested in conformance with the Sate Building Code.This permit may be revoked at any time for due cause. 1 / / Applicant Permitee Signature j Date Issued By Signature Date / SEPAATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.