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CITY OF ORONO � <br /> 2750 KELLEY PARKWAY * � 0 1 S — fd 1 0 7 1 * <br /> DATE ISSUED: 08/2U2015 <br /> ORONO, MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 185 OLD CRYSTAL BAY RD N <br /> PIN : 33-118-23-34-0001 <br /> LEGAL DESC : UNPLATTED 33 118 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> COIVSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: THIS$2500 ESCROW IS TIED TO 2015-00978-PAID BY DAWN MOONEY <br /> APPLICANT ESCROW FEE-APPLICANT 2,500.00 <br /> TOTAL 2,500.00 <br /> ETAL,LYDON STUBBS Payment(s) <br /> 185 OLD CRYSTAL BAY RD N CHECK 3169 2,500.00 <br /> LONG LAKE,MN 55356- <br /> OWNER <br /> Chamberlain Fine Custom Homes <br /> CAMERON, PAUL <br /> 11578 CHAMBERLAIN CT <br /> EDEN PRAIRIE,MN 55346- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this pertnit 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 oniy the work described and dces <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 I80 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 /> Applicant Permitee Signature Date Issued By Signature Date <br />