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CITY OF ORONO I*Izll I IhI_I'�I I I 4I4I III <br /> 2750 KELLEY PARKWAY DATE ISSUED: 11/03/2017 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 930 COX FARM RD <br /> PIN : 27-118-23-33-0013 <br /> LEGAL DESC : SHADOWOOD FARM <br /> : LOT 010 BLOCK 001 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: (1)WATER CLOSET,(2)LAVATORIES,(1)SHOWER,(1)FLOOR DRAIN <br /> VALUATION OF PLUMBING 3000 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> NRH PLUMBING INC. STATE SURCHARGE PLBG(VALUATION) 1.50 <br /> 8751 162ND LANE NW MAIL-IN FEE 2.00 <br /> ANOKA,MN 55303- TOTAL 53.50 <br /> (612)900-7728 Payment(s) <br /> Minnesota State License#: CHECK 5248 53.50 <br /> plbg-PC644503,HV AC-MB004 801 <br /> OWNER <br /> KILLINGSTAD,MR.&MRS. <br /> 930 COX FARM 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 or related work which requires separate <br /> permits. 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 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 conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> /it08/ /7 <br /> Applicant Permi ee Signature Date Issued By Sature Date <br />