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CITY OF ORONO * z 0 1 z - 0 0 5 0 7 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 06/07/2012 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 190 CYGNET PL <br /> PIN : 04-117-23-22-0021 <br /> LEGAL DESC : SWAN LAKE ADDN <br /> : LOT 004 BLOCK 003 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES- MULTIPLE <br /> NOTE: 1 KI"TCHEN SINK <br /> 1 DISPOSAL <br /> 1 DISHWASHER <br /> 1 WATER HEATER <br /> VALUAT[ON OF PLUMBING 1900 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> H[LLCOR PLUMBING STATE SURCHARGE PLBG(VALUATION) 0.95 <br /> 53 TERRACE RD NE TOTAL 50.95 <br /> ST MICHAEL, MN 55376- <br /> (763)688-0342 PAID WITH CC# 2293 <br /> Minnesota State License#: PC645327 <br /> OWNER <br /> FREEMAN, MR. & MRS. <br /> 190 CYGNET PL <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. 'Chis 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 for a period of 180 days at any time after work has commenced. <br /> The applicant is nsible for assuring all reyuired inspections are <br /> requested onf ance with the State Building Code.This pemiit may bc <br /> revok at a �me Dr ue cause. <br /> �� � iz�t� � l l <br /> Applic t Permitee Signature Date [ssued By Si ture Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E. <br />