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CITY OF ORONO PERMIT NO.: 2009-00329 <br /> � 2750 KELLEY PARKWAY <br /> � ORONO, MN 55356- �ATE IssuEv: 06/17/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 101 CHEVY CHASE DR <br /> PIN : 36-118-23-41-0006 <br /> LEGAL DESC : HILL O'WAY MANOR <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: CONNECT BACK FLOW TO LAWN IRRIGATION <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> LEON DUDA PLUMBING STATE SURCHARGE PLBG(<$500) 0.50 <br /> 208 l 7TH AVE N TOTAL 15.50 <br /> HOPKINS,MN 55343 <br /> (952)933-5636 PAID WITH CC# 8018 <br /> OWNER <br /> ESTHER,ALBERT <br /> 101 CHEVY CHASE DR <br /> WAYZATA, MN 55391 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which[his 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 onl the work described and does <br /> not grant permission for additional or rel work which requires separate <br /> permits. All provisions of laws and ord ces governing this type of work <br /> shall be compied wit the r not cified herein.This permit will <br /> expire and become d d if c truction authorized is not <br /> commenced with a f the e of issuance,or if construction is <br /> suspended for a e d 8 day any time after work has commenced. <br /> The applicant r o le for a ring all required inspections are �� <br /> requested in nf ce ith t State Building Code.This permit may be <br /> revoked at y ti e cau e. j <br /> �_. <br /> � � � � � ��-- � (� � ( � <br /> � L_t G�"�}'1�� 1't <br /> / / <br /> Applicant Per ee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />