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{ . ,�. CITY OF ORONO * 2 0 1 6 - 0 1 0 6 5 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 08/30/2016 <br /> ORONO,MN 55356- <br /> (952 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4640 NORTH ARM DR W <br /> PIN : 06-117-23-23-0005 <br /> LEGAL DESC : UNPLATTED 06 117 23 <br /> : LOT 000 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$2500 ESCROW IS TIED TO BUILDING PERMIT 2016-01059 <br /> APPLICANT ESCROW FEE-BUILDING 2,500.00 <br /> TOTAL 2,500.00 <br /> IVERSON,DANIEL&LINDA Payment(s) <br /> 4640 NORTH ARM DR W CHECK 6491 2,500.00 <br /> MOi1ND,MN 55364- <br /> OWNER <br /> IVERSON,DANIEL&LINDA <br /> 4640 NORTH ARM DR W <br /> MOLJND,MN 55364- <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 /> / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br />