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� � " CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 3 - PJ 0 6 7 1 * <br /> DATE ISSUED: 07/18/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3415 CRYSTAL BAY RD <br /> PIN : 17-117-23-43-0118 <br /> LEGAL DESC : WILEYS PARK LAKE MTKA <br /> : LO"1' 002 BC,OCK 001 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPF. : RES[DENTIAL <br /> CONSTRUC"I'ION TYNE : REPAIR <br /> NO"I1�:: RI:PLnCI;A SI�:C�I�ION OI� PIPE-CLL:AN-OU�I� <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> BENJAMIN FRANKLIN PLUMBING STATE SURCHARGE SEWER& WATER 5.00 <br /> 1424 3RD STREET N <br /> MINNEAPOLIS, MN 5541 I- TOTAL 55.00 <br /> (763) 755-6468 PAID WITH CC# 8985 <br /> OWNER <br /> ELSHAZLY, YOUSRY& KAREN <br /> 3415 CRYSTAL BAY RD <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> Thc 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 E3uilding 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 Yor a period of 180 days at any time afier work has commenced. <br /> The applicant is responsible ti�r assuring all required inspections are <br /> requestcd in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cau �. <br /> �-.." _ <br /> ---'% ���- 7 � l� � l 3 c� � /� � <br /> , t Permitee Signature Date Issuc� y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />