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CITY OF ORONO I* 12 OII� it 12 I-IO1; 0' 41 Iz 11 <br /> 1 I* <br /> 2750 KELLEY PARKWAY DATE ISSUED: 05/17/2012 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 840 OLD CRYSTAL BAY RD S <br /> PIN : 09-117-23-12-0002 <br /> LEGAL DESC : UNPLATTED 09 117 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ESCROW FEE-OTHER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-OTHER <br /> NOTE: ESCROW TIED TO BUILDING PERMIT 2011-01003 FOR TEMPORARY CERTIFICATE OF OCCUPANCY <br /> APPLICANT ESCROW FEE-OTHER 10,000.00 <br /> WILLIAMS,JAMES&HEIDI TOTAL 10,000.00 <br /> 840 OLD CRYSTAL BAY RD S <br /> WAYZATA,MN 55391- <br /> OWNER <br /> WILLIAMS,JAMES&HEIDI <br /> 840 OLD CRYSTAL BAY RD S <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 /> revo • any time for due cause. <br /> Ap• ieant Permitee Signature Date Issu=o B'Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK,4 THER THAN DESCRIBED ABOVE. <br />