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• CITY OF ORONO * 2 0 1 2 — 0 0 5 6 6 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/20/2012 <br /> ORONO,MN 55356— <br /> (952) 249-4600 FAX: (952)249-4616 <br /> ADDRESS : 495 OXFORD RD <br /> PIN : OS-117-23-41-0011 <br /> LEGAL DESC : STIELOWS ADDN <br /> : LOT 003 BLOCK 001 <br /> PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> NOTE: ESCROW FOR DEMO PERMIT 2012-00527 <br /> APPLICANT ESCROW FEE-BUILDING 2,000.00 <br /> SAMPLE,MIKE&ANNE TOTAL 2,000.00 <br /> 1449 BAY RIDGE RD <br /> WAYZATA,MN 55391- <br /> (952)847-3159 <br /> OWNER <br /> SAMPLE,MIKE&ANNE <br /> 1449 BAY RIDGE RD <br /> WAYZATA,MN 55391- <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 conswction authorized is not <br /> commenced wi in 180 days of the date of issuance,or if construction is <br /> suspended for period of 180 t any time after work has commenced. <br /> The applicant responsible or ass ring all required inspections are <br /> requested i nformance wi the tate ilding Code.This permit may be <br /> revoked a� time for e c se. <br /> � � / ZU / �c�t / / <br /> pplicant P rmitee Signature Date Issued By Si re Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO E. <br />