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CITY OF ORONO * 2 0 1 5 - 0 1 5 3 6 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 12/09/2015 <br /> / ORONO,MN 55356- <br /> 952 249-4600 FAX: (952 249-4616 <br /> ADDRESS : 4645 ST.ANDREWS ST <br /> PIN : T000121 <br /> LEGAL DESC : LAKEVIEW OF ORONO <br /> : LOT 14 BLOCK 3 <br /> PERMIT TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-TIED TO BUILDING PERMIT <br /> NOTE: ESCROW FOR NEW HOME PERMIT#2015-01430-PAID BY:SWANSON HOMES-CK#36125-$2,500.00 <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> Source Land Development Inc. TOTAL 2,500.00 <br /> 18215 45TH AVE N Payment(s) <br /> CHECK 36125 2,500.00 <br /> STE D <br /> PLYMOUTH,MN 55446- <br /> (763)551-0100 <br /> OWNER <br /> Source Land Development Inc. <br /> 18215 45TH AVE N <br /> STE D <br /> PLYMOUTH,MN 55446- <br /> AGREEMENT AND SWORN STATEMENT <br /> 1'he work for which this pertnit 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 /> 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 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 are <br /> requested in confortnance with the State Building Code.This permit may be <br /> revoked at aay time for d cause. G,�/1 <br /> /2 � . 'G// <br /> ,�e��s� ,�- 9, / <br /> Applicant P itee Signature Da Issued By Signat Date <br />