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CITY OF ORONO * 2 0 1 4 - 0 1 2 3 9 <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/23/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS 1000 WILLOW DR S <br /> PIN : 10-117-23-21-0004 <br /> LEGAL DESC UNPLATTED 10 117 23 <br /> LOT 000 BLOCK 000 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : ESCROW FEE-APPLICANT <br /> NOTE: THIS$5000.00 ESCROW IS TIED TO BUILDING PERMIT-201401060 <br /> APPLICANT ESCROW FEE-APPLICANT 5,000.00 <br /> KLOMBIES, LINDSAY&ANNA <br /> ESCROW FEE-DEVELOPER 0.00 1000 WILLOW DR S Payment(s) <br /> TOTAL 5,000.00 <br /> WAYZATA, MN 55391 ts) <br /> CHECK 10015 5,000.00 <br /> OWNER <br /> KLOMBIES,LINDSAY&ANNA <br /> 1000 WILLOW DR 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 /> revoked at any time for due cause. <br /> Applicant Permitee Signature Date Issued By Signature Date <br />