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CITY OF ORONO * 2 pJ 1 4 — fd 1 1 9 8 * <br /> n 2750 KELLEY PARKWAY DATE ISSUED: 10/15/2014 <br /> ` ORONO,MN 55356- <br /> (952)249-4600 FAX: 952 249-4616 <br /> ADDRESS : 4064 NORTH SHORE DR <br /> PIN : 07-117-23-44-0085 <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: MOVING(1)WATER CLOSET,(1)LAVATORY,AND(1)BATHTUB <br /> VALUATION OF PLUMBING 1000 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 0.50 <br /> JANET M OBRIGEWITSCH,DAN H PHIPPS& TOTAL 50.50 <br /> 4064 NORTH SHORE DR Payment(s) <br /> MOiJND,MN 55364- CHECK 260 50.50 <br /> OWNER <br /> JANET M OBRIGEWITSCH,DAN H PHIPPS& <br /> 4064 NORTH SHORE DR <br /> MOUND,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 separate <br /> permits. All provisions of laws and ordinances goveming this type of work <br /> shall be compied with whe[her 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 conforman with the te Building Code.7'his permit may be <br /> revoke time for due cause. <br /> � � /o� /S� <br /> Applicant Permitee Signature Date ssue y Signature Date <br />