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• <br /> CITY OF ORONO 111 <br /> Ii. 7 I 0i li i6'I 3i* 20 31'I 1w <br /> 2750 KELLEY PARKWAY DATE ISSUED: 12/15/2017 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 800 OLD CRYSTAL BAY RD N <br /> PIN : 28-118-23-43-0010 <br /> LEGAL DESC : N/A <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : INSTITUTIONAL-SCHOOL <br /> CONSTRUCTION TYPE : BACKFLOW DEVICE/TESTING/REPAIR <br /> ACTIVITY : BACKFLOW DEVICE <br /> APPLICANT BACKFLOW PREVENTER TESTING/REPAIR 10.00 <br /> STATE SURCHARGE FLAT-ADDITIONAL 1.00 <br /> COMMERCIAL PLUMB&HEATING INC. TOTAL 11.00 <br /> 24428 GREENWAY AVENUE <br /> Payment(s) <br /> FOREST LAKE,MN 55025 CREDIT CARD 8934 11.00 <br /> (651)464-2988 <br /> OWNER <br /> Orono School District 278 <br /> 685 OLD CRYSTAL BAY RD N <br /> PO BOX 46 <br /> LONG LAKE,MN 55356-0046 <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 /> Applicant Permitee Signature Date Issued By Signature Date <br />