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GENERAL PERNIIT <br />crrY OF ORONO <br />P.O. BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner <br />Contrat:tor. Lai <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: NEW <br />Inside Plumbing (MSxtures ) Fee S <br />Water Meter (Sire ) Fee S <br />Meter # <br />CITY PERMIT N? 8845 <br />Date - — Alt <br />Address Z2 �f l�X, k <br />Address /< l ry 1 �,I!� 6 1114f— <br />City f <br />O ADDITION 0 REPAIR O REMODEL <br />Remote p <br />Municipal Water Connection Fee S _ <br />f] Copper O <br />Municipal Sewer Connection Fee S 5 LiL <br />O PVC * Cast O <br />MWCC SAC Charge Fee S <br />On Site F; .'i, System Fee S <br />ACKNOWLEDGEMENT <br />The unik1%kroed hereby ttckno%ktlgcs reLvip d this limited permit. <br />tniudnttg aurlxamv d all special inkwmmxwt. terms. cttnlrliorcs tw <br />reytrremeruc %mien abmr. The undemittrnd understands and agrees <br />under penalty tdta% that this permit is Vridh hmiard in Volt Io the work. <br />attisily tw tmprosrmrm specified: that this permit dtte, ntl grant am <br />autldmty ludo wtwk tw actisitirs rrquinng xparate permit approsals: and <br />Oral this prrtnil dace r%4 gram audw my to sioiate am prosi%ion d any City <br />twditamr tw State law. rule or regulatitm All wtwk shall Ise dime in strict <br />comril.ani with all Cay twdirrmr, hwiding ndles and tw health <br />department rrguhatxwn, and .hall he suhjmi to inspection. approsal of <br />rciectxxt by the City Whensrr sit ordered. the unkrvgned agrees to <br />owmt any wtwk f4wind to be in siolautm of the ctwtthoorn of this permit <br />Si .<�of Applicant ' <br />�--e c- <br />Water Well <br />Fee S <br />Mechanical Equipment <br />Fee S <br />Fireplace/Wood Stove <br />Fee S <br />Moving/Lifting Buildings <br />Fee S <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fee S <br />Design Review <br />Fee S <br />Fire <br />Fee S <br />Sprinkler System (Fire) <br />Fee S <br />Other. <br />Fee S <br />After -the -fact Investigation <br />Fee S <br />TOTAL <br />State Surcharge: <br />Fee S <br />• JV <br />Total Amount Paid to City Fee $2t <br />�t�#J1�X3 <br />This permit is not valid u-ttil the proper fee is paid and it is approved <br />by an authorized City Official. <br />Signature of City Official <br />Ctxk' Whitt, Filr Copy Canary InsMior's Copy Ping Finance Copy Cxslrl- Aprrlicant's Rempt <br />