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CITY OF ORONO * 2 0 1 5 - 0 1 2 9 2 * <br /> , 2750 KELLEY PARKWAY DATE ISSUED: 10/06/2015 <br /> � � ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 960 FERNDALE RD W <br /> PIN : 02-117-23-44-0017 <br /> LEGAL DESC : COUNTRY CLUB ESTATES <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : VACUUM BREAKER <br /> NOTE: ADD A VACUUM BREAKER FOR LAWN [RRIGATION <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> STATE SURCHARGE PLBG(<$500) 1.00 <br /> B& D PLUMB[NG&HEATING INC. MAIL-IN FEE 2.00 <br /> 4145 MACKENZIE CT NE <br /> ST MICHAEL, MN 55376- TOTAL 18.00 <br /> (763)497-2290 Payment(s) <br /> CREDIT CARD 8094 18.00 <br /> OWNER <br /> BROOKS,JOHN&JOAN <br /> 960 FERNDALE RD W <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 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 cause. ,���`�� <br /> ) <br /> �� � � � �L� � ��.� � � � t—� �` '�� � Y� �'�/ ���-� <br /> � <br /> Applicant Permitee Signatu e Date Issued By Signature Date <br />