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4 � ' <br /> CITY OF ORONO * z a 1 z - 0 1 1 1 z * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/3U2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2640 FOX ST <br /> PIN : 04-117-23-42-0008 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1249 <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 /> NOTG: "I�HIS$2500 ESCROW [S"1'lED"f0 I3UILDING PGRMI"1�#2012-01081-PD CHt?CK#5849 <br /> APPLICANT ESCROW FEE- BUILDING 2,500.00 <br /> WESTLING,THOMAS& LORI ESCROW FEE- EROSION CONTROL 0.00 <br /> 2640 FOX ST <br /> WAYZATA, MN 55391- ESCROW FEE-GRADING 0.00 <br /> (952)331-3924 TOTAL 2,500.00 <br /> OWNER <br /> WESTLING, THOMAS& LORI <br /> 2640 FOX ST <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued sha11 be perfonned according to <br /> thc 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 arc <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 13y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />