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( � <br /> CITY OF ORONO * 2 0 1 3 - 0 0 4 9 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/13/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS ; 2100 SHADYWOOD RD <br /> PIN : 17-117-23-31-0041 <br /> LEGAL DESC : WILEYS PARK LAKE MTKA <br /> : LOT 030 BLOCK 001 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: THIS$2000.00 ESCROW IS TIED TO ZONING PERMIT 2013-00493-PD CK#5132 BY STEVEN HICKS <br /> APPLICANT ESCROW FEE-APPLICANT 2,000.00 <br /> CONCRETE SCIENCE SERVICES ESCROW FEE-DEVELOPER 0.00 <br /> 7545 COMMERCE ST. WEST <br /> CORCORAN,MN 55340- TOTAL 2,000.00 <br /> (612)616-7323 <br /> OWNER <br /> MARHULA,DAREN <br /> 2100 SHADYWOOD 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 sepazate <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 wifl <br /> expire and become nulf 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 />