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. ' <br /> ! <br /> CITY OF ORONO * 2 0 1 4 - 0 1 3 8 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 12/02/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2801 FOX ST <br /> PIN : 04-117-23-34-0004 <br /> LEGAL DESC : FARVIEW <br /> : LOT 001 BLOCK 003 <br /> PERMIT TYPE : PLUMBING (<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NO�I�E?: WATER IiF.A"fl?R <br /> APPLICANT PLUMB[NG F[XTURE FEE (<$500) 15.00 <br /> STATE SURCHARGE PLBG (<$500) 5.00 <br /> CHAMPION PLUME3ING LLC MAIL-IN FEE 2.00 <br /> 3670 DODD ROAD- SUITE 100 <br /> EAGAN, MN 55123- TOTAL 22.00 <br /> �� Payment(s) <br /> CHECK 30057 22.00 <br /> OWNER <br /> KLUI�I I, DAN & MAGG[E <br /> 2801 FOX ST <br /> LONG LAKF., MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> Che work for�rhich this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. 'Chis permit is for only the work described and docs <br /> not grant permission for additional or related work which requires separatc <br /> pennits. All provisions ot�laws and ordinances governing this type of work <br /> shall be compied with�vhether or not specilied hcrein.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 timc after work has commenced. <br /> l�he applicant is responsible for assuring all required inspec[ions are <br /> requested in conformance with the State[3uilding Code.'I�his permit may bc <br /> rcvoked at any time for duc cause. <br /> C� � � � �/� ��_� p ����� <br /> ilpplicant Permitee Signatur Date Issued _�Signatu Date <br />