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z CITY OF OR NO PERMIT NO.: 2011-01591 <br /> � 2750 KELLEY PA WAY <br /> ORONO, MN 55 56- DATE ISSUEn: 12/30/2011 <br /> 952 249-4600 FAX: 9 2 249-4616 <br /> ADDRESS : 4105 BAYSIDE RD <br /> PIN : 06-117-23-14-0023 <br /> LEGAL DESC : BAYSIDE RIDGE <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: PLUMBING FIXTURES: I <br /> (1)WATER CLOSET,(2)LAVATORIES,(1)SHOWER <br /> VALUATION OF PLUMBING 8450 <br /> � - <br /> APPLICANT <br /> PLUMBI G FIXTURE FEE 105.63 <br /> PLUMBING SERVICES, INC. STATE S RCHARGE PLBG (VALUATION) 4.22 <br /> 7938 NORTH SHORE TRAIL <br /> FOREST LAKE,MN 55025- MAIL-IN FEE 2.00 <br /> Minnesota State License#: 58570PM TOTAL 111.85 <br /> PAI WITH CC# 8362 <br /> OWNER <br /> BURKE,NICK& SUE <br /> 4105 BAYS[DE RD <br /> MAPLE PLAIN, MN 55359- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be perfonned 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 pennission 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 j <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 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 a ny time f�pr due cause. <br /> GQ /zl� l �� ��0� � l <br /> Applicant Permitee Sign e Date Iss d y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK O HER THAN DESCRIBED ABOVE. <br />