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� CITY OF ORONO PERMIT NO.: 20ll-00087 <br /> � • � 2750 KELLEY PARKWAY <br /> i ORONO,MN 55356- DATE ISSUED: 02/08/2011 <br /> � 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2256 SHADYWOOD RD <br /> ; PIN : 17-117-23-43-0125 <br /> LEGAL DESC : WILEYS PARK LAKE MTKA <br /> : LOT 006 BLOCK 001 <br /> ' PERMIT TYPE : ESCROW FEE-TIED TO BiJILDING PERMIT <br /> ; PROPERTY TYPE : RESIDENTIAL <br /> � CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> NOTE: THIS$2500.00 ESCROW IS TIED TO BUILDING PERMIT#2011-00021 <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> BURKE, FORREST&RENEE TOTAL 2,500.00 <br /> 2256 SHADYWOOD Rb <br /> WAYZATA, MN 55391- <br /> OWNER <br /> BURKE,FORREST&RENEE <br /> 2256 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 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 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 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 />