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CITY OF ORONO <br /> ' �' 2750 KELLEY PARKWAY * Z 0 1 4 - 0 0 3 3 2 * <br /> DATE ISSUED: 04/18/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2625 CASCADE LA <br /> PIN : 33-118-23-11-0116 <br /> LEGAL DESC : STONEBAY FIFTH ADDITION <br /> : LOT 006 BLOCK 001 <br /> PERMIT TYPE : SEWER& WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: WA7�I�;R& SGWER CONNI:CTION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> T& J CONCRETE STATE SURCHARGE SEWER& WATER 5.00 <br /> 9100 BALTIMORE STREET NE <br /> BLAINE, MN 55449- TOTAL 105.00 <br /> (763)413-0988 Payment(s) <br /> Minnesota State License#: SW-646112 CHECK ]2865 105.00 <br /> OWNER <br /> BU[LDERS LI,C, STONEBAY <br /> 16135 SSTH AVENUE NORTH <br /> PLYMOUTH, MN 55446- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> State Quilding Code. This permit is for only the worh 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 rype of work <br /> shall be compied with whether or not speciYied 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 conslruction is <br /> suspended Yor a period of 180 days at any time after work has commenced, <br /> l�he applicant is responsible tbr assuring all required inspections aze <br /> requested in confbrmance�tiith Ihe State Building Code.�l�his permit may be <br /> revoked at any time for due cause. <br /> ���`��-c�..� �/���'��y� l��l� <br /> Applicant Permitee Signature Date Issu By Signature Date <br />