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CITY OF ORONO * 2012 - 01089 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/26/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952)249-4616 <br /> ADRESS 2643 THOROUGHBRED LA <br /> PIN : 04-117-23-12-0021 <br /> LEGAL DESC OLD CRYSTAL BAY ROAD 2ND ADDN <br /> LOT 006 BLOCK 002 <br /> P:RMIT TYPE ESCROW FEE-TIED TO BUILDING PERMIT <br /> P OPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE ESCROW FEE-TIED TO BUILDING PERMIT <br /> N TE: THIS$2500 ESCROW IS TIED TO BUILDING PERMIT#2012-01042-PD BY CHECK#5252 <br /> APPLICANT <br /> ESCROW FEE-BUILDING 2,500.00 <br /> C AMPLIN,JUDSON&ALEYA TOTAL 2,500.00 <br /> 2643 THROUGHBRED LA <br /> LONG LAKE,MN 55356- <br /> OWNER <br /> C AMPLIN,JUDSON&ALEYA <br /> 2613 THROUGHBRED LA <br /> LONG LAKE,MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> tht approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This permit is for only the work described and does <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shol be compied with whether or not specified herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> su$pended 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 conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />