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. CITY OF ORONO PERMIT NO.: 2011-01143 <br /> f 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE ISSUED: 09/29/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDR�SS : 4195 HIGHWOOD RD <br /> PIN : 07-117-23-44-0022 <br /> LEGAL DESC : HIGHWOOD LAKE MTKA <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: FIXTURES: <br /> (2)WATER CLOSETS,(2)LAVATORIES,(2)BATHTUBS,AND(1)SHOWER <br /> VALUATION OF PLUMBING 8000 <br /> APPLICANT PLUMBING FIXTURE FEE 100.00 <br /> GRABOW PLUMBING,INC. STATE SURCHARGE PLBG(VALUATION) 4.00 <br /> 8420 REDWOOD STREET TOTAL 104.00 <br /> COON RAPIDS,MN 55433 <br /> �) <br /> Minnesota State License#: 038623PM <br /> OWNER <br /> SMITH,DOUGLAS&ROBAN <br /> 4195 HIGHWOOD RD. <br /> MOLJND,MN 55364 <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 sepazate <br /> permits. Al(provisions of laws and ordinances goveming 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 /> ��/., cv G� . �- p i .�r i �r g ,�Z.�,L <br /> .Applicant Permitee Signature Date Issu y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />