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� ' ` CITY OF ORONO <br /> 2750 KELLEY PARKWAY * � 0 1 6 - PJ 0 1 3 4 * <br /> DATE ISSUED: 02/10/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1220 BRACKETTS POINT RD <br /> PIN : 11-117-23-32-0018 <br /> LEGAL DESC : RGT ORONO POINT <br /> : LOT 000 BLOCK 000 <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 BUILDNG PERMIT 2016-00133-PAID BY WELCH FORSMAN ASSOCIATES <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> TOTAL 2,500.00 <br /> WELCH FORSMAN ASSOCIATION Payment(s) <br /> 6026 PILLSBURY AVE S CHECK 32985 2,500.00 <br /> MINNEAPOLIS,MN 55402- <br /> (612)827-4455 <br /> Minnesota State License#: BUIL-BC005890 <br /> OWNER <br /> HANNAFORD,JULE&ELIZABETH <br /> 1220 BRACKETTS PT 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 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 /> / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br />