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, .� CITY OF ORONO * 2 0 1 4 - 0 1 2 9 5 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 11/OS/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3309 CRYSTAL BAY RD <br /> PIN : 17-117-23-41-0016 <br /> LEGAL DESC : WALLACES ADDN TO VIL OF MTKA B <br /> : LOT 001 BLOCK 000 <br /> PFRMIT TYPE : PLUMBING (> $500) <br /> PROPERTY TYPE : RESIDENT[AL <br /> CONSTRUCTION TYPE : FIXTURES- MULTIPLF, <br /> NOTE: (4)WATERCLOSETS,(4)LAVATORIES,(1)I3ATHTUB,(3)SHOWERS,(1)K1TCtfI;N SINK,(1)D[SPOSAL,(1)DISHWASHER <br /> (2)SILLCOCKS,(l)FLOOR DRAIN,(1)WASHER,(1)WATER HEATER <br /> VALUATION OF PLUMBING 11000 <br /> APPLICANT PLUMBING FIXTURE FEE 137.50 <br /> STATE SURCHARGE PLBG (VALUATION) 5.50 <br /> P.H. MECHANICAL INC TOTAL 143.00 <br /> 5056 SULGROVE RD <br /> MOUND, MN 55364- Payment(s) <br /> (612)418-I 12� CHECK 8865 143.00 <br /> OWNER <br /> SCHMID, DAVID <br /> 3309 CRYSTAL BAY RD <br /> WAYZATA, MN 55391- <br /> AGREEMF,NT AND SWORN STATEMENT <br /> The work for which this permit is issucd shall bc performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This pennit is for onl��the work describcd and docs <br /> not grant permission for additional or rclated work which requires separate <br /> permits. All provisions of IaH�s 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 tbr a period of 180 days al any[ime after work has commenced. <br /> 1'he applicant is responsible for assuring all required inspections are <br /> reques[ed in con�omianee with the State Building Code."This permit may be <br /> revoked at any tf�ne for due cause. <br /> ` C %�� �/�� (�_ / ( / � // <br /> Applicant Permitee Signature Date Issu By Signature Date <br />