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� •.. <br /> � CITY OF ORONO <br /> 2750 KELLEY PARKWAY * z 0 1 4 - 0 1 1 4 7 * <br /> DATE ISSUED: 10/06/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3818 NORTH SHORE DR <br /> PIN : 08-117-23-34-0064 <br /> LEGAL DESC : CRYSTAL BAY VIEW <br /> : LOT MB BLOCK MB <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: REPLACE DISHWASHER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> STATE SURCHARGE PLBG(<$500) 5.00 <br /> MN PLUMBING&APPLIANCE INC. MAIL-IN FEE 2.00 <br /> 14105 RUTGERS STREET NE TOTAL 22.00 <br /> PWOR LAKE,MN 55372- <br /> (952)469-8341 Payment(s) <br /> Minnesota State License#: cont-58455-PM CHECK 1316 22.00 <br /> OWNER <br /> JOHNSON, PAULA <br /> 3818 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 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 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> � �� � �- /D i 8 i/ <br /> Applicant Permitee ignature Date Issu By Signature Date <br /> / <br />