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i <br /> 1 1 <br /> CITY OF ORONO I 1 �1 1 L <br /> 2750 KELLEY PARKWAY DATE ISSUED: 08/24/2012 <br /> ORONO,MN 55356- <br /> , (952) 249-4600 FAX: (952)249-4616 <br /> ADDRESS : 505 OLD CRYSTAL BAY RD S <br /> PIN : 04117-23-31-0003 <br /> LEGAL DESC : A DITOR'S SUBD.NO.230 <br /> : L T 022 BLOCK 000 <br /> PERMIT TYPE : E CROW FEE-TIED TO BUILDING PERMIT <br /> PROPERTY TYPE SIDENTIAL <br /> CONSTRUCTION TYPE : E CROW FEE-TIED TO BUILDING PERMIT <br /> NOTE: THIS$2500 ESCROW IS TIE TO BUILDING PERMIT#2012-001295-PD CHECK#3314 BY DAVID HARMANN <br /> I <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> HARMANN,DAVID&MONA ESCROW FEE-EROSION CONTROL 0.00 <br /> 505 OLD CRYSTAL BAY RD S <br /> LONG LAKE,MN 55356- ESCROW FEE-GRADING 0.00 <br /> TOTAL 2,500.00 <br /> OWNER <br /> HARMANN,DAVID&MONA <br /> 505 OLD CRYSTAL BAY RD S ' <br /> LONG LAKE,MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued sh 1 be performed according to <br /> the approved plans and specifications,appli able City approvals,and the <br /> State Building Code. This permit is for onl the work described and does <br /> not grant permission for additional or relate work which requires separate <br /> permits. All provisions of laws and ordinan.es governing this type of work <br /> shall be compied with whether or not specifi-d herein.This permit will <br /> expire and become null and void if construe don authorized is not <br /> commenced within 180 days of the date of i•suance,or if construction is <br /> suspended for a period of 180 days at any ti e after work has commenced. <br /> The applicant is responsible for assuring all equired inspections are <br /> requested in conformance with the State Bui ding 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 />