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CITY OF ORONO * z 0 1 5 - 0 0 0 1 8 * <br /> � ,�•► 2750 KELLEY PARKWAY DATE ISSUED: OU07/2015 <br /> ORONO,MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1480 SIXTH AVE N <br /> PIN : 26-118-23-32-0008 <br /> LEGAL DESC : DOUGLAS ESTATES <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: (1)WATER CLOSET AND(1)LAVATORY <br /> VALUATION OF PLUMBING 500 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 0.25 <br /> SAM HENDRICKSON PLBG&HEATING INC TOTAL 50.25 <br /> 29901 725TH AVE <br /> DASSEL,MN 55325- Payment(s) <br /> CHECK 12636 50.25 <br /> OWNER <br /> GULBRANDSON,DAN&ERICKA <br /> 1480 SIXTH AVE N <br /> LONG LAKE,MN 55356- <br /> AGREEMENT AND SWORI�T STATEMENT <br /> 1'he 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 sepazate <br /> permits. All provisions of laws and ordinances goveming this type of work <br /> shali be compied with whether or not specified herein.l'his permit will <br /> expire and become null and void if conswction 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 e Building Code.This permit may be <br /> revoked at any time for d ca <br /> �--�ti � / / /�J <br /> Applicant Permi ee Signature Date Issu y Signature Date <br />