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CITY OF ORONO PERMIT NO.: 2011-01491 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUEn: i U30/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3095 NORTH SHORE DR <br /> PIN : 09-117-23-32-0014 <br /> LEGAL DESC : REG.LAND SURVEY NO.0670 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: IRON FILTER <br /> VALUATION OF PLUMBING 0 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> CLEARWATER SYSTEMS,INC. STATE SURCHARGE PLBG(VALUATION) 5.00 <br /> 1519 148TH AVE NW TOTAL 55.00 <br /> ANDOVER,MN 55304 <br /> (763)434-0445 <br /> Minnesota State License#: 61240 <br /> OWNER <br /> SIME,MICHAEL&PAMELA <br /> 1592 MEDINA RD <br /> LONG LAKE,MN 55356- <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 ot related work which requires sepazate <br /> permiu. 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 conswction is <br /> suspended for a period of 180 days at any time after work has commenced. <br /> The applicant i sponsible for ing all required inspections aze <br /> reque ed ita�onformance ' the tate Building Code.This permit may be <br /> rev�at any time for e ca . <br /> , , l.�i�(��� <br /> .,F �� , o �� � ��l <br /> �cant Pe ' e�i n ure Date Issue y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />