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CITY OF ORONO � 1 5 - 0 1 3 1 9 * <br /> « 2750 KELLEY PARKWAY DATE ISSUED: 10/12/2015 <br /> ORONO,MN 55356- <br /> # 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1990 SHADYWOOD RD <br /> pIN : 17-117-23-24-0027 <br /> LEGAL DESC : SHADY-WOOD <br /> : LOT 040 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: 3 WATER CLOSETS,5 LAVATORY,3 BATHTUBS, 1 SHOWER, 1 KITCHEN SINK, 1 DISHWASHER,2 SILCOCKS, 1 FLOOR <br /> DRAIN, <br /> 1 LAUNDRY TRAY, 1 WASHER, 1 WATER HEATER, 1 WATER SOFTNER <br /> VALUATION OF PLUMBING 14000 <br /> APPLICANT PLUMBING FIXTURE FEE 175.00 <br /> STATE SURCHARGE PLBG(VALUATION) 7.00 <br /> SAM HENDRICKSON PLBG&HEATING INC MAIL-IN FEE 2.00 <br /> 29901 725TH AVE <br /> DASSEL,MN 55325- TOTAL 184.00 <br /> Minnesota State License#:plbg-PC646230,mech-MB005006 Payment(s) <br /> CREDIT CARD 7507 184.00 <br /> OWNER <br /> VONFELDT&ELAINE WYATT,JEFF <br /> 1990 SHADYWOOD 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 dces <br /> not grant permission for additional or related work which requires separate <br /> permiu. 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 /> l� <br /> � d � �o ��`�(� ) o � tZ �iS <br /> Applicant Permitee Signatu Date Issued By Sign re Date <br />