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CITY OF ORONO * z a 1 3 - 0 Pl 0 4 2 * <br /> z <br /> � 2750 KELLEY PARKWAY DATE ISSUED: OU16/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2735 COUNTRYSIDE DR W <br /> PIN : 04-] 17-23-12-OO18 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 003 BLOCK 003 <br /> PERMIT TYPE : PLUMBING (>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES- MULTIPLE <br /> N01�E: KITCHF.N SINK.DISPOSAL AND DISHWASHGR <br /> VALUATION OF PLUMBING 500 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> H�LLCOR PLUMB[NG STATE SURCHARGE PLBG (VALUATION) 0.25 <br /> 53 TERRACE RD NE <br /> ST MICHAEL, MN 55376- • TOTAL 50.25 <br /> (763)688-0342 PAID WITH CC# 2293 <br /> Minnesota State License#: PC645327 <br /> OWNER <br /> ALEXANDER, TIM <br /> 2735 COUNTRYSIDE DR W <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issucd shall bc pertixmcd accordin�to <br /> the approved plans and specifications,applicablc 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 diis 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 atter work has commenced. <br /> The applicant is r sible for assuring all required inspections are <br /> requested in c �ancc with the State[3uilding Code.This permi[may be <br /> revoked a n ime for d use. <br /> / i lG i zo r �✓� ( i �co i �3 <br /> Applicant Pe itee Signature Datz Issu� Si nalurc Datc <br /> Y� € <br /> SEPARATE PERMITS REQUIRED FOR WORK OT ER THAN DESCRIBED ABOVE. <br />