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, - CITY OF ORONO * Z 0 1 5 — 0 1 3 7 7 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/26/2015 <br /> ORONO, MN 55356— <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1629 BOHNS POINT RD <br /> PIN : 17-117-23-11-0005 <br /> LEGAL DESC : REG. LAND SURVEY NO.0565 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: (1)WATER CLOSET <br /> (1)LAVATORY <br /> (1)KITCHEN SINK <br /> (1)DISPOSAL <br /> (1)DISHWASHER <br /> VALUATION OF PLUMBING 4500 <br /> APPLICANT PLUMBING FIXTURE FEE 56.25 <br /> STATE SURCHARGE PLBG(VALUATION) 2.25 <br /> VAN WINKLE PLUMBING TOTAL 58.50 <br /> 5430 TEAL ST Payment(s) <br /> BIG LAKE,MN 55309- CHECK 1816 58.50 <br /> (612)599-2124 <br /> Minnesota State License#:plbg-005756 <br /> OWNER <br /> AMPLATZ,CAROLINE <br /> 345 LEAF ST <br /> WAYZATA,MN 55391- <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 onty the work described and does <br /> not grant permission for additional or related work which requires separate <br /> permiu. All provisions of laws and ordinances governing this rype 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 /> �y �� l��l.L� <br /> � �kc� /C <br /> Applicant Permitee Sig e Date Issu y Signature Date <br /> � � I , <br />