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� � 1 CITY OF ORONO * z 0 1 5 - 0 1 1 5 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/09/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1629 BOHNS POINT RD <br /> PIN : 17-117-23-I1-0005 <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: (3)WATER CLOSETS,(4)LAVATORIES,(1)BATHTUB AND(2)SHOWERS <br /> VALUATION OF PLUMBING 6900 <br /> APPLICANT PLUMBING FIXTURE FEE 86.25 <br /> STATE SURCHARGE PLBG (VALUATION) 3.45 <br /> VAN WINKLE PLUMBING TOTAL 89J0 <br /> 5430 TEAL ST <br /> BIG LAKE, MN 55309- Payment(s) <br /> (612)599-2124 CREDIT CARD 3870 89.70 <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 only[he work described and does <br /> not grant permission for addi[ional 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 construc[ion authorized is not <br /> commenced within I80 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 at any time for due cause. <br /> - �- ls � , ,l�S <br /> Applicant Permitee Signature Date Issued Signature Da e <br />