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CITY OF ORONO * 2 0 1 4 — PJ 1 0 8 2 * <br /> .� 2750 KELLEY PARKWAY DAT� �sSUE�: 09/23/2014 <br /> � ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1 165 FERNDALE RD W <br /> P[N : 02-117-23-43-0026 <br /> LEGAL DESC : NORTH SHORE COTTAGE ACRES LAKE <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE -APPLICANT <br /> NO"I'l�` ESCROW"I'IF.D"I'O"T.ONING nPPLICATION 14-3693 <br /> ANPLICANT ESCROW FEE -APPLICANT 2,500.00 <br /> TOTAL 2,500.00 <br /> BROOK, ROE3ER"I' Payment(s) <br /> 1 165 FERNDALE RD W CHGCK 15399 2,500.00 <br /> WAYZATA, MN 55391- <br /> OWNER <br /> BROOK, ROBERT <br /> 1165 FEKNDALE RD W <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> l�he work fbr which this permit is issued shall be perlormed according to <br /> the approved plans and specilications,applicable City approvals,and the <br /> Statc Building Code. This permit is for only thc work described and docs <br /> not grant permission tor additional or related work which requires separate <br /> permits. All provisions of la���s and ordinances governing this type of work <br /> shall be compied with whcther or not specitied hcrein."I�his pemiit«ill <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 days of tl�e dafe of issuance,or if construction is <br /> suspended for a period of 180 days at any time afrer work has commenced. <br /> The applicant is responsible Yor assuring all required inspections are <br /> requested in conformance wiU�the State 13uildin2 Code.This pemiit may be <br /> revoked at any time for due cause. <br /> / / <br /> Applicant Permitee Signature Date Issued 13��Signature Date <br />