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CITY OF ORONO * 2 0 1 5 - 0 1 3 0 9 * <br /> 2750 KELLEY PARKWAY DATE [SSUED: 10/14/2015 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> AI➢DRESS : 2450 COUNTRYSIDE DR <br /> PIN : 04-117-23-11-0004 <br /> LEGAL DESC : COUNTRYSIDE MANOR <br /> : LOT 002 BLOCK 001 <br /> PERM[T TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RES[DENT[AL <br /> COI�ISTRUCTIOI�1 TYPE : FIXTURES- MULT[PLE <br /> NOTE: 2 WATER CLOSETS,3 LAVATORY, l BATHTUB, l SHOWER <br /> VALUATION OF PLUMBING 4000 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG (VALUAT[ON) 2.00 <br /> WINKLER, SHAUN& STACIA TOTAL 52.00 <br /> 2450 COLJNTRYSIDE DR Payment(s) <br /> LONG LAKE, MN 55356- CHECK 2459 52.00 <br /> OWNER <br /> W[NKLER, SHAUN & STACIA <br /> 2450 COUNTRYSIDE DR <br /> LONG LAKE,MN 55356- <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 the work described and does <br /> no[gran[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 are <br /> requcsted in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br />