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� CITY OF ORONO �0 1 3 — 0 1 2 1 0 * <br /> 2750 KELLEY PARKWAY nATE IssuEn: 1U13/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 365 FERNDALE RD N <br /> PIN : 36-118-23-41-0002 <br /> LEGAL DESC : UNPLATTED 36 1 18 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTF: REPLACE DISHWASF�[ER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> ECOWATER STATE SURCHARGE PLBG(<$500) 5.00 <br /> 3208 FIRST STREET S <br /> WAITE PARK, MN 56387- MAIL-IN FEE 2.00 <br /> (320)251-2505 TOTAL 22.00 <br /> PAID WITH CC# 3331 <br /> OWNER <br /> TERRILL, DONALD& KIMBERLY <br /> 365 FERNDALE RD N <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> Thc �cork for���hich this permit is issucd shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State[3uilding Code. This permit is 1br only the work described and docs <br /> not grant permission 1�or 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 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 responsible for assuring all required inspections are <br /> requested in conformance with thc State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> �1���,�� /li /.� l /� ��,�� <-c.� /f / f�l z <br /> Applicant Permitee Signature Date Iss By Signature Date - <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />