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� CITY OF ORONO * z 0 1 5 - 0 0 7 7 e * <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-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: ESCROW FOR IN-GROLIND 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,MICHAEL&KATHLEEN Payment(s) <br /> 2655 COLINTRYSIDE DR W CHECK 5335 2,500.00 <br /> LONG LAKE, MN 55356- <br /> OWNER <br /> VOSSEN,MICHAEL&KATHLEEN <br /> 2655 COUNTRYSIDE DR W <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 /> the approved plans and specifications,applicable Ciry 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 sepazate <br /> permits. A11 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 /> � �, / � � �/� � <br /> � � 1�=�' 0 � i"��(� C� � � (o� js <br /> Applicant Permitee Signature Date Issued By Signature Date <br />