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, <br /> ' CITY OF ORONO PERMIT NO.: 2012-00029 <br /> 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE ISSUED: OU1U2012 <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 MTK�A <br /> : LOT 017 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: (1)WATER CLOSET,(1)LAVATORY,(1)BATHTUB AND�(1)SHOWER <br /> VALUATION OF PLUMBING 4100 <br /> APPLICANT PLUMBING FIXTURE FEE 51.25 <br /> SOUTHTOWN PLUMBING INC. <br /> 6636 PENN 'STATE SURCHARGE PLBG(VALUATION) 2.05 <br /> RICHFIELD,MN 55423 TOTAL 53.30 <br /> (612)866-3057 <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 pertnit is issued shall be performed according to <br /> the approved plans and specifications,appiicable 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 /> permits. All provisions of laws and ordinances goveming 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 consWction 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 c or ith the State Building Code.This permit may be ' <br /> revoked t ause. <br /> l f 1 / � / l / l a-- <br /> A li ermi ignature Date Issu By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />