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t , CITY OF ORONO * 2 0 1 3 - 0 1 0 3 7 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/02/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4445 NORTH SHORE DR <br /> PIN : 07-117-23-31-0001 <br /> LEGAL DESC : BERGQUISTS ADDN TO SAGA HILL <br /> : LOT 003 BLOCK 000 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOT'E: THIS$2,000 ESCROW IS TIED TO ZONING PERMIT 2013-01038 <br /> APPLICANT ESCROW FEE-APPLICANT 2,000.00 <br /> BLANK,KRYSTYNA TOTAL 2,000.00 <br /> 12010 RIVERBEND ROAD <br /> 34984- <br /> OWNER <br /> BLANK,KRYSTYNA <br /> 12010 RIVERBEND ROAD <br /> , 34984 <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 /> no[grant permission for additional or related work which requires sepazate <br /> permits. All provisions of laws and ordinances goveming this type of work <br /> shall be compied with whether or not specified herein.T'his 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 /> 7'he applicant is responsible for assuring all required inspections are <br /> requested in conformance with the State Building Code.This pertnit may be <br /> revoked at any time for due cause. <br /> / / / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />