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CITY OF ORONO I I' I I! 1 1 1 1 1 1 1 <br /> 2750 KELLEY PARKWAY * 2 1 7 - 0 1 2 <br /> DATE ISSUED: 10/09/22 011 <br /> 7 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 490 OLD LONG LAKE RD <br /> PIN : 36-118-23-34-0010 <br /> LEGAL DESC : SUMMIT STATION <br /> : LOT 003 BLOCK 001 <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$1,000 ESCROW IS TIED TO ZONING PERMIT APPLICATION 2017-01226 PAID BY SOUTHVIEW DESIGN PAID CHECK# <br /> 36763 <br /> APPLICANT ESCROW FEE-BUILDING 1,000.00 <br /> SOUTHVIEW DESIGN TOTAL 1,000.00 <br /> Payment(s)2383 PILOT KNOB RD <br /> CHECK 36763 1,000.00 <br /> MENDOTA HEIGHTS,MN 55120- <br /> (651)203-3000 <br /> OWNER <br /> LITSEY,CAL&CHRISTINE <br /> 490 OLD LONG LAKE RD <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 /> /0/ Gii/� <br /> Applicant Permitee Signature Date Issue y Signature Date <br />