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CITY OF ORONO * z � 1 6 - 0 0 0 1 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: O1/05/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1560 FOX ST <br /> PIN : 02-117-23-32-0006 <br /> LEGAL DESC : MACMILLAN ADDN <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTIOIY TYPE : ESCROW FEE-APPLICANT <br /> NOTE: ESCROW FOR LAND USE APPL[CATION#16-3800-PA[D BY: WHITNEY MACMILLAN-CK#00159530-$700.00 <br /> APPLICANT ESCROW FEE-APPLICANT 700.00 <br /> MACMILLAN, WHITNEY TOTAL 700.00 <br /> Payment(s) <br /> PO BOX 5628 CHECK 00159530 700.00 <br /> M[NNEAPOLIS, MN 55440-5628 <br /> � OWNER <br /> MACMILLAN,WHITNEY <br /> PO BOX 5628 <br /> MINNEAPOL[S, MN 55440-5628 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be perfornied according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This permit is for only[he 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 no[specified herein.This permit will <br /> expire and become null and void if construction au[horized is no[ <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 afier 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 /> I� ,� ���..�'��� � <br /> I��1��(� �_,�-� ����.�,��- (� L;���'1 I` �-��: �I �� ' � 5 � !�" <br /> Applicant Permitee Signature Date Issued By Signature Date <br />