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CITY OF ORONO I*I I I I 1 I 1 II 1 111 111111 11I� IIL <br /> * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/16/2016 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> • <br /> ADD CESS4665 WEST BRANCH RD <br /> PIN} : 07-117-23-22-0015 <br /> LEGAL DESC : WEST BRANCH HILL <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: ESCROW TIED TO ZONING PERMIT#2016-01060-PAID BY:BRIGITEE HAMBLIN-CK#3066-$2,000.00 <br /> APPLICANT ESCROW FEE-APPLICANT 2,000.00 <br /> TOTAL 2,000.00 <br /> &BRIGETTE HAMBLIN,ERIC TRUSKOSKI Payment(s) <br /> 4665 WEST BRANCH RD CHECK 3066 2,000.00 <br /> MOUND,MN 55364- <br /> OWNER <br /> &BRIGETTE HAMBLIN,ERIC TRUSKOSKI <br /> 4665 WEST BRANCH RD <br /> MOUND,MN 55364- <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 /> 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 are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> Vae � /.2/ <br /> h �e e k O <br /> 9/4 / <br /> ( <br /> Applicant le itee Signature Date Issued By Signature Date <br />