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CITY OF ORONO PERMIT NO.: 2010-00115 <br /> • 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 03/OU2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> REPRINTED ON 6/29/2010 <br /> ADDRESS : 2172 SHADYWOOD RD <br /> PIN : 17-117-23-42-0010 <br /> LEGAL DESC : WILEYS PARK LAKE MTKA <br /> : LOT 000 BLOCK 001 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: THIS ESCROW OF$2500.00 IS TIED TO VARIANCE APPLICATION#10-3456-PAID WITH CHECK#10880 <br /> APPLICANT ESCROW FEE-APPLICANT 2,500.00 <br /> DORE, STEVEN TOTAL 2,500.00 <br /> 8351 WEST 109TH STREET <br /> BLOOMINGTON,MN 55438- <br /> (952)35&3303 <br /> OWNER <br /> DORE, STEVEN <br /> 8351 WEST 109TH STREET <br /> BLOOMINGTON,MN 55438- <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 re►ated 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 speci5ed herein.Tt►is 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 are <br /> requested in conformance with the State Building Code.This percnit 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 />