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�, CITY OF ORONO * 2 0 1 s — 0 1 4 0 e� <br /> 2750 KELLEY PARKWAY DATE ISSUED: 1U07/2016 <br /> ORONO,MN 55356- <br /> (952 249-4600 FAX: (952)249-4616 <br /> ADDRESS : 3145 NORTH SHORE DR <br /> PIN : 09-117-23-33-0013 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1 I 13 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRLTCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: PLUMBING FIXTURES <br /> (2)WATER CLOSETS,(2)LAVATORIES,(2)SHOWERS <br /> VALUATION OF PLUMBING 11500 <br /> APPLICANT PLUMBING FIXTURE FEE 143.75 <br /> STATE SURCHARGE PLBG(VALUATION) 5.75 <br /> VICTORIA PLUMBING TOTAL 149.50 <br /> 1855 WEST 80TH ST Payment(s) <br /> P.O.BOX 174 CHECK 9118 149.50 <br /> VICTORIA,MN 55386 <br /> (952)443-0034 <br /> Minnesota State License#:PLUM-644463 <br /> OW1vER <br /> PETERSON, SVERON <br /> 3145 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 speci6cations,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 separate <br /> permits. 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 of the date of issuance,or if construction is <br /> suspended for a per f 1 days at any time after work has commenced. <br /> The applicant is re pons le f assuring all required inspections are <br /> request in nfo anc with e State Building Code.This permit may be <br /> e a an t' for d cau e. <br /> � � `l <br /> _ z_ �� �-�►,�� <br /> ant Permitee Signature Date Issued y Signature Date <br />