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.,,� CITY OF ORONO * z 0 1 5 - 0 0 � 1 9 * <br /> r 2750 KELLEY PARKWAY DATE ISSUED: O1/07/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: (952 249-4616 <br /> ADDRESS : 3895 SHORELINE DR <br /> PIN : 20-117-23-22-0004 <br /> LEGAL DESC : TOWNSITE OF LANGDON PARK <br /> : LOT 000 BLOCK 008 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES- MULTIPLE <br /> NOTE: I WATER CLOSET, 1 LAVATORY, 1 BATHTUB <br /> VALUATION OF PLUMBING 2100 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 1.05 <br /> VERSANT PLUMBING CO. TOTAL 51.05 <br /> 5601 331 AVE NW Payment(s) <br /> CAMBRIDGE, MN 55008- CHECK 6734 51.05 <br /> (763)238-4703 <br /> Minnesota State License#: plbg-643677 <br /> OWNER <br /> RAUSCHENDORFER,JOE& SANDY <br /> 3895 SHORELINE DR <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 /> permi[s. All provisions of laws and ordinances goveming[his type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become null and void if cons[ruction authorized is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of l80 days at any time afrer work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with the S[ate Building Code.This permit may be <br /> � <br /> revoked at any time for due cause. _ r� , ) ' <br /> i � <br /> � . � /'/ / <br /> � � �-� S ��-=t C �`�1'1,��r r i il f <br /> Applicant Permitee Signature Date Issued By Signat re Date <br />