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_ ,� CITY OF ORONO * 2 0 1 3 — 0 0 0 7 0 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OU28/2013 <br /> ORONO, MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 2178 SHADYWOOD RD <br /> PIN : 17-117-23-42-0009 <br /> LEGAL DESC : WILEYS PARK LAKE MTKA <br /> : LOT 017 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: PLUMBING FIXTURES: (1)KITCHEN SINK,(1)DISPOSAL,(1)DISHWASHER,AND(1)MISC FIXTURE <br /> VALUATION OF PLUMBING 1700 <br /> APPLICANT <br /> SOUTHTOWN PLUMBING INC. PLUMBING FIXTURE FEE 50.00 <br /> 6636 PENN STATE SURCHARGE PLBG(VALUATION) 0.85 <br /> RICHFIELD,MN 55423 MAIL-IN FEE 2.00 <br /> (612)866-3057 TOTAL 52.85 <br /> OWNER <br /> ANDERSON,MR.&MRS.CURTIS <br /> 2178 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 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 /> ^ �� � � i3 LS�Y?/t�C- / /oZ�'/ /3 <br /> � <br /> Applic t Permitee Signat Date Issue y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />