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CITY OF ORONO PERM[T NO.: 2010-00895 <br /> "" 2750 KELLEY PARKWAY <br /> � ' ORONO, MN 55356- �ATE [ssuEn: 09/24/2010 <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4099 HIGHWOOD RD <br /> PIN : 07-117-23-44-0012 <br /> LEGAL DESC : HIGHWOOD LAKE MTKA <br /> : LOT 014 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: CONNECT NF,W ADDITION W/4" SCHDULE 40-SE�ATTACHED(PER LYLE OMAN) <br /> VALUATION OF PLUMB[NG 1300 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> TUMA CONSTRUCTION STATE SURCHARGE PLBG (VALUATION) 5.00 <br /> 5045 COUNTY ROAD 19 <br /> MINNETR[STA, MN 55359- TOTAL 55.00 <br /> (763)479-2982 PAID WITH CC# 4077 <br /> OWNER <br /> SERAN III, ALONZO <br /> 4099 HIGHWOOD RD <br /> MOUND, MN 55364- <br /> AGREEMENT AND SWORN STATEMENT <br /> "I'he 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. 'Chis 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 I 80 days of the date of issuance,or if construction is <br /> suspended Yor a period of 180 days at any time after work has commenced. <br /> The appl nt is res nsible for suring all required inspections are <br /> reques m conY ia wi , ate Building Code.This permit may be > <br /> revo� at any e for du ause. /�✓ /� <br /> � z�/ �d `?� (' �_ t �n�'i!'�/ / j `��� ��. <br /> pplican ermitee Signature Date Issued By Sig ature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />