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A <br /> CITY OF ORONO Iif '1 ' I' I 1111 I 11 <br /> 2750 KELLEY PARKWAY * 2 7 - 0 1 5 7 <br /> DATTEE ISSUED: 1U15/22 017 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 850 WILLOW DR N <br /> PIN : 27-118-23-33-0021 <br /> LEGAL DESC : WOLFS RUN <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: (1)WATER CLOSET,(3)LAVATORIES,(1)KITCHEN SINK,(1)DISPOSAL,(1)DISHWASHER <br /> VALUATION OF PLUMBING 2500 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 1.25 <br /> MANATEE PLUMING INC. <br /> 1208 165TH ST TOTAL 51.25 <br /> YOUNG AMERICA,MN 55397- Payment(s) <br /> CHECK 9401 51.25 <br /> OWNER <br /> CARLSON,THOMAS D <br /> 850 WILLOW DRIVE N <br /> LONG LAKE,MN 55356- <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 /> 4y , ) 7 t i/ h!6 <br /> Applicant Permitee Signature Date Issued By��' 'gnature Date <br />