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RR CITY OF ORONO * Z 0 1 7 — 0 0 1 9 3 * <br /> • � 2750 KELLEY PARKWAY DATE ISSUED: 03/02/2017 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2800 SHADYWOOD RD <br /> pIN : 21-117-23-13-0023 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1196 <br /> : LOT 000 B LOCK 000 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: NEW FIXTURES: 5 WATER CLOSETS,6 LAVA'IORY, 1 BATHTUB,4 SHOWER, 1 KITCHEN SINK, 1 DISPOSAL, 1 DISHWASHER, <br /> 2 SILLCOCK5, <br /> 1 FLOOR DRAIN, 1 LAUNDRY TRAY,2 WASHERS, 1 WATER HEATER <br /> VALUATION OF PLUMBING 23700 <br /> APPLICANT PLUMBING FIXTURE FEE 296.25 <br /> STATE SURCHARGE PLBG(VALUATION) 11.85 <br /> COX PLUMBING LLC TOTAL 308.10 <br /> 17041 172ND AVE SE Payment(s) <br /> BIG LAKE, MN 55309- CHECK 6406 308.10 <br /> (612)242-9247 <br /> Minnesota State License#: plbg-PC6441 19 <br /> OWNER <br /> BERGH, HANS&SHARON <br /> 2800 SHADYWOOD RD <br /> EXCELSIOR,MN 55331- <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 E3uilding 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 constraction authorized is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of 1 AO 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 E3uilding Code.This permit may be <br /> revoked at time for due cause. <br /> �� � � �:�� f`G�...��. ''�c �� __�- .. ��-�. ,i�f.�� ..� <br /> 'I!��✓�—v `' l �= l l �� <br /> App ' ant Permitee Signature Date Issued By Signature Date <br />