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CITY OF ORONO * 2 0 1 5 - 0 1 2 8 6 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 10/05/2015 <br /> * ' ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 965 EDGEWOOD HILLS RD <br /> PIN : 02-117-23-14-0001 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1098 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCTION TYPE : FIXTURES- MULTIPLE <br /> NOTE: REPLACE 1 K[TCHEN SINK,I D[SPOSAL& 1 DISHWASHER <br /> VALUATION OF PLUMBING 1250 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 0.63 <br /> GLACIER PLUMBING INC MAIL-1N EEE 2.00 <br /> 680 VALHALLA DR NE <br /> CEDAR, MN 55011- TOTAL 52.63 <br /> (763)413-1883 Payment(s) <br /> Minnesota State License#: plbg-PC643630 CHECK 7554 52.63 <br /> OWNER <br /> BJORK, ROBERT&BETH <br /> 965 EDGEWOOD HILLS RD <br /> WAYZATA, MN 55391- <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 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 applican[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 cause. f�� � <br /> f % <br /> ��� �� �� � -� �.�,L_ � F �(�_� � � (_\ � � � _ � �_� <br /> � � �' (,� / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br />