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y CITY OF ORONO �0 1 4 — PJ fd 2 2 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 03/19/2014 <br /> ORONO, MN 553�6- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2650 COUNTRYSIDE DR W <br /> PIN : 04-117-23-12-0014 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 006 BLOCK 002 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: "rIED TO BUILDING PERMIT 2013-01069 <br /> APPLICANT ESCROW FEE-APPLICANT 2,500.00 <br /> TOTAL 2,500.00 <br /> JOEZGENSON, ROBERT Payment(s) <br /> 2650 COUNTRYSIDE DR W CHECK 15798 2,500.00 <br /> LONG LAKE, MN 55356 <br /> OWNER <br /> JORGENSON, ROBERT <br /> 2650 COUNTRYSIDE DR W <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for�chich 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 whed�er or not specified herein.This permit will <br /> eapire and become null and void if construction authorized is not <br /> commenced within 180 days of the date of issuance,or if consvuction 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 time for due cause. <br /> � � �� / / <br /> Applieant Permitee S gnaturev Date Issued [3v S� ture � Da[e <br />