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CITY OF �JRONO * z 0 1 5 - 0 0 7 7 8 * <br /> , � 2750 KELLEY PARKWAY DATE ISSUED: 06/16/2015 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2655 COUNTRYSIDE DR W <br /> PIN : 04-117-23-13-0006 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 006 BLOCK 003 <br /> PERMIT TYPE : ESCROW FEE-APPL[CANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPL[CANT <br /> NO"I'F,: ESCROW FOR IN-GROUND POOL,PERMIT#2015-00776, PAID BY OWNER MR.&MRS. VOSSEN-CK#5335-$2,500.00 <br /> APPLICANT ESCROW FEE-APPLICANT 2,500.00 <br /> TOTAL 2,500.00 <br /> VOSSEN, M[CHAEL&KATHLEEN Payment(s) <br /> 2655 COUNTRYSIDE DR W CHECK 5335 2,500.00 <br /> LONG LAKE, MN 55356- <br /> C i ty o i �,'r����io <br /> OWNER 17,J Kelley Parkway <br /> Orono MN 5535F� y52-245 d�OU <br /> VOSSEN, MICHAEL& KATHLEEN <br /> 2655 COtJNTRYS[DE DR W R��-eipt Nu: 3.013630 .lun i6. 2015 <br /> LONG LAKE,MN 55356- <br /> Michael & Kathleen Vossen <br /> Flanniny and Zoning <br /> 2015-00778 2C�55 �,500.OU <br /> AGREEMENT AND SWORN STATEMENT Countrysitle Dr W <br /> 101-22205 <br /> The work for which this permit is issued shall be performed according to UefBYY"B� REV-DEV�IGper DepOSl t <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 Total: ______2_500_OJ_ <br /> not grant permission for additional or related work which requires separate [:heCk <br /> permits. All provisions of laws and ordinances goveming this type of work Check No: 5335 c.5���•�� <br /> shall be compied with whether or not specified herein.This permit will n���.. <br /> expire and become null and void if construction authorized is not " ' <br /> commenced within l80 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 aze <br /> requested in conformance with[he State Building Code.This permit may be <br /> revoked at any time for due cause. ? <br /> �,, <br /> i� i,'{r', <br /> �`( I \(.�- l.�i�,� ,�; 1 �'J � �'� � l�,.�'� �C_ <br /> .�; . <br /> Applicant Permitee Signature � Date Issued B Sig ure Date <br />