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CITY OF ORONO * 2 PJ 1 3 - 0 0 7 7 0 * <br /> , 2750 KELLEY PARKWAY DATE ISSUED: 08/06/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : ]003 COX FARM RD <br /> PIN : 27-118-23-33-0014 <br /> LEGAL DESC : SHADOWOOD FARM <br /> : LOT 002 BLOCK 002 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NO"I'F,: PRESSURF?VACUi!M BREAKI?R FOR I,AWN IRRIGATION <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> MARK KUEBELBECK PLBG STATE SURCHARGE PLBG(<$500) 5.00 <br /> 8516 34TH AVE N <br /> NEW HOPE, MN 55428- TOTAL 20.00 <br /> (763)227-4305 PAID WITH CC# 4556 <br /> OWNER <br /> HARTLEIN, DANIEL&JULIA <br /> 1003 COX FARM RD <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORN STATEMENT <br /> Thc work for which this permit is issucd shall be performed according to <br /> thc approved plans and specifications,applicable City approvals,and the <br /> State Building Code. 'I'his 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 goveming this type of work <br /> shall be compied with whether or not specified herein.'I�his 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 commeneed. <br /> 7�he applicant is responsible for assuring al ui d inspections are <br /> requested in � nform pce with � B ' �ng Co e.This permit may bc <br /> v at� � e f d use � <br /> / <br /> ! '� l l �� O / C.OI � <br /> Ap licant Per tee Signature � Date Issued Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />