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� <br /> CITY OF ORONO PERMIT NO.: 2011-00191 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �AT� �ssuE�: 04/OU2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3300 FOX ST <br /> PIN : OS-117-23-44-0003 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1358 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING (> $500) <br /> PROPERTY TYPE : RESIDENT[AL <br /> CONSTRUCT(ON TYPE : FIXTURES- MULTIPLE <br /> No�rr�,: r�LUM�i�v� i��ixr�lrzr:s: <br /> (1)EACH-Wn"I�ER CL,OS1;"I�,LAVATORY, SI IOWGR,KI�fCI IEN SINK. DISIIWASHER, FLOOR llRA1N, W�1TER I IGATER <br /> VALUATION OF PLUMBING 4675 <br /> APPLICANT PLUMBfNG FIXTURE FEE 58.44 <br /> NOW1'HEN PLUMBING STATE SURCHARGE PLBG (VALUATION) 5.00 <br /> 19960 FERRET ST. <br /> ELK RIVER, MN 55330 MAIL-IN FEE 2.00 <br /> (763)753-5216 TOTAL 65.44 <br /> PAID W[TH CC# 5814 <br /> OWNER <br /> � I�RUBECK, WILLIAM &JUDITH <br /> 3300 FOX ST <br /> LONG LAI<E, MN �5356- <br /> AGREEMENT AND SWORN STATEMENT <br /> Thc work for which this permit is issued shall bc performed according to <br /> thc approved plans and specifications,applicable City approvals,and the <br /> State l3uilding Code. This permit is for only lhe work described and does <br /> not grant permission for adclitional or related work which requires separate <br /> permits. All provisions of laws and ordinances goveming this rype of work <br /> shall be com�ied with���hether or not specified herein.This pennit will <br /> e�pire and bccome null and void if construction authorized is not <br /> commcnced�viUiin I 80 days of lhe datc of issuancc,or if construction is <br /> suspended for a period of I 80 days at an��time atter�vork has commenccd. <br /> Thc applicant is responsible for assuring all required inspcctions are <br /> requested in conformance with the State 13uilding Code.This permit ma��be <br /> revoked al•any time for due cause. <br /> / / � / �/ <br /> Applicant Permitce Signaturc Date Issu� y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />