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CITY OF ORONO III 11111111111111111111 0 1 <br /> 2750 KELLEY PARKWAY DATE ISSUED: 11105/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 364 WESTLAKE ST <br /> PIN : 05-117-23-23-0043 <br /> LEGAL DESC : HILLSIDE PARK <br /> : LOT 000 BLOCK 001 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: THIS$7500 ESCROW IS TIED TO BUILDING PERMIT 2014-00137 FOR ISSUANCE OF A TEMPORARY CERTIFICATE OF <br /> OCCUPANCY <br /> APPLICANT ESCROW FEE-APPLICANT 7,500.00 <br /> ESCROW FEE-DEVELOPER 0.00 <br /> Identisys, Inc. TOTAL 7,500.00 <br /> SHIELDS TRUSTEES,JANELLE K&MICHAEL R <br /> Payment(s) <br /> 7630 COMMERCE WAY CHECK 9180 7,500.00 <br /> EDEN PRAIRIE, MN 55344- <br /> OWNER <br /> Identisys, Inc. <br /> SHIELDS TRUSTEES,JANELLE K&MICHAEL R <br /> 7630 COMMERCE WAY <br /> EDEN PRAIRIE, MN 55344- <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 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 are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> Applicant Permitee Signature Date Issued By Signature Date <br />