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CITY OF ORONO * Z 0 1 5 - 0 0 0 6 6 * <br /> - • . 2750 KELLEY PARKWAY DATE ISSUED: OU2U2015 <br /> � ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADnRESS : 1340 FOX ST <br /> PIN : 02-117-23-31-0019 <br /> LEGAL DESC : MINNETONKA BLUFFS <br /> : LOT 000 BLOCK 014 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: TIiIS$2500 ESCROW IS TIED TO ZONING PERMIT 15-3717 <br /> APPLICANT ESCROW FEE-APPLICANT 2,500.00 <br /> ESCROW FEE-DEVELOPER 0.00 <br /> CHAMBERLAIN CAPITAL <br /> 11578 CAHMBERLAIN COURT TOTAL 2,500.00 <br /> EDEN PRAIRIE, MN 55344-6 Payment(s) <br /> CHECK 866 2,500.00 <br /> OWNER <br /> CHAMBERLAIN CAPITAL <br /> 11578 CAHMBERLAIN COURT <br /> EDEN PRAIRIE, MN 55344-6 <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 goveming this type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expirc 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 I80 days at any time afrer work has commenced. <br /> The applicant is responsible for assuring all required inspections aze <br /> requested in conformance with the State Building Code.This permi[may be <br /> revoked at any time for due cause. <br /> / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br />