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� CITY OF ORONO * Z QJ 1 4 - PJ 0 9 6 5 * <br /> r 2750 KELLEY PARKWAY DATE ISSUED: 08/28/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 770 DICKEY LAKE DR <br /> PIN : 27-118-23-33-0010 <br /> LEGAL DESC : RINGERSWOOD <br /> : LOT 007 BLOCK 001 <br /> PERMIT TYPE : PLUMBING (> $500) <br /> PROPERTY TYPE : RF_SIDENTIAL <br /> CONSTRUCTION TYPE : WATER 1{EATER <br /> VALUA'[�ION OF PLUMBING I500 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG (VALUATION) 0.75 <br /> LEGACY MECH SERVICES MAIL-IN FEE 2.00 <br /> 114 THOMAS CIRCLE#]06 TOTAL 52.75 <br /> MONTICELLO, MN 55362- <br /> (763)314-0877 Payment(s) <br /> CHECK 7476 52J5 <br /> OWNER <br /> LEUKUMA, CHARLES& J[LL <br /> 770 DICKEY LAKE DR <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 specitications,applicable City approvals,and the <br /> State Ruilding Code. 'I�his permit is for only the work described and does <br /> not grant permission fbr 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 /> eapire and become null and void if constniction authorized is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of I 80 days at any time alter work has commenced. <br /> I�he applicant is responsible for assuring all required inspections are <br /> requested in conforniance with the State Ruilding Code.'I'his permit may be <br /> revoked at any time for due cause. <br /> / 1 <br /> Applicant Permitce Signature Datc Issucd By i nature Date <br />