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�� '� CITY OF ORONO <br /> 2750 KELLEY PARKWAY * � 0 1 2 - 0 1 2 3 6 * <br /> DATE ISSUED: 12/12/2012 <br /> ORONO, MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3675 JACOBS MILL RD <br /> PIN : 32-118-23-24-0012 <br /> LEGAL DESC : JACOBS MILL <br /> : LOT 002 BLOCK 002 <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$600.00 ESCROW IS TIED TO BULIDNG PERMIT 2012-01217-PD CHECK#1919 BY JEFFREY AMENT <br /> APPLICANT ESCROW FEE-BUILDING 600.00 <br /> AMENT,JEFFREY&KARI ESCROW FEE-EROSION CONTROL 0.00 <br /> 3675 JACOBS MILL RD <br /> LONG LAKE,MN 55356 ESCROW FEE-GRADING 0.00 <br /> TOTAL 600.00 <br /> OWNER <br /> AMENT,JEFFREY&KARI <br /> 3675 JACOBS MILL RD <br /> LONG LAKE,MN 55356 <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 goveming 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 /> / / / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />