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• � CITY OF ORONO *� 4 — 0 1 0 4 0 * <br /> 2750 KELLEY PARKWAY nATE �ssuE�: 09/15/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2695 DEER RUN TR E <br /> PIN : 04-117-23-13-0012 <br /> LEGAL DESC : CRYSTAL BAY PRESERVE <br /> : LOT 005 BLOCK 001 <br /> PERM[T TYPE : PLUMBING (<�,500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NO"I'[,: R};PLACE WA�I�E:R EI1:A"I�I?R <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> STATE SURCHARGE PLBG (<$500) 5.00 <br /> APPLIANCE CONNECTIONS MAIL-IN FEE 2.00 <br /> 12850 CHESTNUT BLVD <br /> SHAKOPEE, MN 55379 TOTAL 22.00 <br /> (952)445-4803 Payment(s) <br /> Minnesota State License#; cont-057209PM CHECK 5384 22.00 <br /> OWNER <br /> BERMAN, ARTHUR & KATHERINF. <br /> 2695 DEER RUN TR E <br /> LONG LAKF„ 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. This permit is for only the work described and does <br /> not grant pern�ission 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 specitied herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced N�ithin 180 days of the date of issuance,or if construction is <br /> suspended fbr a period of 180 days at any time after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requcsted in conformance with the State Quilding Codc.This pemiit may be <br /> revoked at any time for due cause. <br /> C ,s � c� � is� � <br /> Applicant Permitee Signature ate Is ed By Signature Date <br />