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CITY OF ORONO * Z 0 1 5 - 0 0 3 9 3 * <br /> f ` 2750 KELLEY PARKWAY DATE ISSUED: 04/08/2015 <br /> • ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 129 CHEVY CHASE DR <br /> PIN : 36-118-23-41-0020 <br /> LEGAL DESC : HILL O'WAY MANOR <br /> : LOT O15 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES- MULTIPLE <br /> NOTE: 1 LAVATORY, 1 BATHTUB, 1 SHOWER <br /> VALUATION OF PLUMBING 4300 <br /> APPLICANT PLUMBING FIXTURE FEE 53.75 <br /> STATE SURCHARGE PLBG(VALUATION) 2.15 <br /> BRISBIN PLUMBING IN.0 TOTAL 55.90 <br /> 18687 JASPAR ST.NW Payment(s) <br /> RAMSEY,MN 55303 CHECK 5474 55.90 <br /> (612)490-3786 <br /> Minnesota State License#: BUIL-064827PM <br /> OWNER <br /> SAHLSTROM,DAVID&JEAN <br /> 129 CHEVY CHASE DR <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMEIVT <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 the work 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 type 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any[ime for due cause. <br /> 1 $' � S L /�- � � � , � , /`�� <br /> �N�/ �'r�;��S, � — � � � �-�-,-,c,���-� <br /> Applicant Permitee Signature Date [ssued By Signature Date <br />