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III1III 111_ IIHHIllIIIII <br /> CITY OF ORONO * 2 0 1 3 - 00 1 2 8 <br /> 2750 KELLEY PARKWAY DATE ISSUED: 02/22/2013 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 665 ORCHARD PARK RD <br /> PIN : 31-118-23-11-0005 <br /> LEGAL DESC : UNPLATTED 31 118 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ESCROW FEE-OTHER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-OTHER <br /> NOTE: THIS$2500 ESCROW IS FOR THE ACCESSORY STRUCTURE FOR,cAs OR[fl,41U)&4,K RD-PD CHECK#6184 <br /> BY WILLIAM&MOLLIE REYNOLDS 2756 Kelley Parkway. <br /> Orono Ni S53.5-; `a52-249-46 <br /> Receipt No 3.108455 Feb 22, 2013 <br /> Mollie & William 'Reynolds <br /> Planning and Zoning <br /> Acceessory Structure 2,50^..(t <br /> Escrow - b65 Orchard Park <br /> Rd <br /> 101-2205 <br /> Deferred Rev-Developer Deposit <br /> Total: `,500.00 <br /> Check <br /> Check No: 6184 2,500.0b <br /> Payor: <br /> Mollie & idilliaa: Reynolds <br /> Total Applied: 2,504.00 <br /> Chante Tendered: — - 00 • <br /> APPLICANT ESCROW FEE-OTHER 2,500.00 <br /> REYNOLDS,WILLIAM&MOLLIE TOTAL 2,500.00 <br /> 3630 LIVINGSTON AVE <br /> WAYZATA,MN 55391- <br /> (612)940-5747 <br /> OWNER <br /> REYNOLDS,WILLIAM&MOLLIE <br /> 3630 LIVINGSTON AVE <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 /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />