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, *,� CITY OF ORONO PERMIT NO.: 2011-01485 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 1U29/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 805 FOREST ARMS LA <br /> PIN ; 07-117-23-12-0009 <br /> LEGAL DESC : FOREST ARMS <br /> : LOT 001 BLOCK 002 <br /> PERMIT TYPE : ESCROW FEE-T[ED TO BUILDING PERMIT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> NOTE: THIS$500 ESCROW IS ADDITIONAL 1�0 THE ORIGINAL$2000 ESCROIV AND TIED TO DF,MO PERMIT#201 1-01473 AND <br /> BUILIDNG PERMIT-#20 1 1-0 1 475 <br /> APPLICANT ESCROW FEE-BUILDING 500.00 <br /> GURALNIK, ALBERT&VALERIE TOTAL 500.00 <br /> 805 FOREST ARMS LA <br /> MOUND,MN 55364- <br /> . r;��; <br /> OWNER _,,.,- �_� <br /> GURALNIK, ALBERT&VALERIE _ - ;;;�-�;. � <br /> . _ �;,,, � <br /> 805 FOREST ARMS LA <br /> MOUND, MN 55364- <br /> ;r�;.t . <br /> ar�r�in; ar.� > <br /> AGREEMENT AND SWORN STATEMENT 'rj't'��+7,i ;� �t�i <br /> �� f�oresi; f�t� <br /> I'he work for�vhich this permit is issued shall be performed according to ;—����}� <br /> the approved plans and specitications,applicable City approvals,and the "'C+i'rtv P,e�rDe�� <br /> State Building Code. This permit is for only the work described and does <br /> not grant pcnnission for additional or related work which requires separate ��rd,�; �,��. <br /> permits. All provisions of laws and ordinances governing this type of work .M�...__r___.. <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 k �G: �:�rJ ;, <br /> commenced within 180 days of the date of issuance,or if construction is '��� <br /> suspended Yor a period of 180 days at any time after work has commenced. ��'� ���'a��+?ti <br /> <2nt3::i£G�: ,`' <br /> The applicant is responsible for assuring all required inspections are � <br /> requested in conformance with the State Building Code.This permi[may be -�—���"�"� <br /> revoked at any time 1or due cause. ' <br /> / / / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />