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CITY OF ORONO * 2017 - 00052 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 01/19/2017 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)2494616 <br /> ADDRESS 2496 OLD BEACH RD <br /> PIN 21-117-23-22-0006 <br /> LEGAL DESC SHORE HILLS <br /> LOT 005 BLOCK 000 <br /> PERMIT TYPE ESCROW FEE-TIED TO BUILDING PERMIT <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE ESCROW FEE-TIED TO BUILDING PERMIT <br /> NOTE: THIS$700 ESCROW IS TIED TO ZONING PERMIT 2017-00051 <br /> APPLICANT ESCROW FEE-BUILDING 700.00 <br /> CARLSON,GERALD&DIANE TOTAL 700.00 <br /> Payment(s) <br /> 2496 OLD BEACH RD CHECK 11451 700.00 <br /> WAYZATA,MN 55391- <br /> OWNER <br /> CARLSON,GERALD&DIANE <br /> 2496 OLD BEACH RD <br /> WAYZATA,MN 55391- <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 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 /> Applicant Permitee Signature Date Issued By Signature Date <br />