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. � CITY OF ORONO PERMIT NO.: 2009-00810 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE �SSUEu: 1U10/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 965 EDGEWOOD H[LLS RD <br /> PIN : 02-117-23-14-0001 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1098 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMB[NG (>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : F[XTURES- MULTIPLE <br /> NOTE: PLUMBING I'IXTURES: (2)WATER CLOSETS,(3)LAVATORIES,(1)SHOWt:R,(I)SILLCOCK,(l)FLOOR DRAIN,(1) <br /> LAUNDRY TRAY,(1)WASHER,AND(1)WATER HEATER <br /> VALUATION OF PLUMBING 14000 <br /> APPLICANT PLUMBING FIXTURE FEE 175.00 <br /> LAKE SIDE PLUMB& HEATING STATE SURCHARGE PLBG (VALUATION) 7.00 <br /> 12469 ZINRAN AVE S <br /> SAVAGE, MN 55378 MAIL-IN FEE 2.00 <br /> (952)894-7600 TOTAL 184.00 <br /> OWNER <br /> CUSICK, MR. & MRS. THOMAS <br /> 965 EDGEWOOD HILLS RD <br /> WAYZATA, MN 55391 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issucd shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. 'I his 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[his 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 wi[hin 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 responsible for assuring all required inspections are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due ca e. <br /> �/i � zioy' G��� // i /Di D � <br /> Applt ant Permitee Signature Date Is ed By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />