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` , � <br /> CITY OF ORONO * 2 0 1 3 - 0 0 0 4 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OU18/2013 <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: THIS$2500 ESCROW IS TIED TO BULDING PERMIT#2013-00007-PD CHECK#5980-BY MICHAEL SAMPLE <br /> / <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> SAMPLE,MIKE&ANNE ESCROW FEE-EROSION CONTROL 0.00 <br /> 1449 BAY RIDGE RD <br /> WAYZATA,MN 55391- ESCROW FEE-GRADING 0.00 <br /> (952)847-3159 TOTAL 2,500.00 <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 dces <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing 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 aze <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 />