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` . ` CITY OF ORONO PERMIT NO.: Zoiaooaoo <br /> . _ . <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE IssuEn: OS/27/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3115 NORTH SHORE DR <br /> PIN : 09-117-23-32-0013 <br /> LEGAL DESC : REG.LAND SURVEY NO. 0269 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: INSTALL DISHWASHER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> CHAMPION PLUMBING LLC STATE SURCHARGE PLBG(<$500) 0.50 <br /> 3670 DODD ROAD-SUITE 100 <br /> EAGAN,MN 55123- MAIL-IN FEE 2.00 <br /> () MISC FEE 0.00 <br /> Minnesota State License#: 61770PM TOTAL 17.50 <br /> OWNER <br /> VOGT,ELIZABETH <br /> 3115 NORTH SHORE DR <br /> WAYZATA,MN 55391 <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 /> permiu. All 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 confortnance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> /�rC.y`���i' <br /> �t / / / / <br /> Applicant Permitee Signature Date Issued By ature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E. <br />