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� CITY OF ORONO * 2 0 1 6 - 0 1 3 5 7 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 10/24/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2166 SHADYWOOD RD <br /> PIIv : 17-117-23-42-0011 <br /> LEGAL DESC : WILEYS PARK LAKE MTKA <br /> : LOT 000 BLOCK 001 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : RESIDENTIAL <br /> COIVSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: PLUMBING FIXTURES: (1)WATER CLOSET,(1)LAVATORY,(1)SHOWER,(2)KITCHEN S[NK,(2)D[SPOSAL,(2) <br /> DISHWASHER,(1)WET BAR <br /> VALUATION OF PLUMBING 8455 <br /> APPLICANT PLUMB[NG FIXTURE FEE 105.69 <br /> STATE SURCHARGE PLBG(VALUATION) 4.23 <br /> STEWART PLUMBING, INC. MAIL-IN FEE 2.00 <br /> 13025 GEORGE WEBER DR <br /> SUITE#1 TOTAL 111.92 <br /> ROGERS,MN 55374 Payment(s) <br /> (763)428-1833 CREDIT CARD 3122 111.92 <br /> Minnesota State License#:plbg-PC000474,mech-MB003262 <br /> OWNER <br /> LACROIX, STEPHEN&SUSAN <br /> 2166 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 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 l80 days of the date of issuance,or if eonstruction 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 cau�e. • <br /> �'�D ��! �z� /� � �/� <br /> Applicant Permitee Signature Date Issued B ignature Date <br />