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• HMI 1111 111 <br /> CITY OF ORONO <br /> * <br /> 2750 KELLEY PARKWAY * 2 1 7 - 0 0 6 <br /> DATE ISSUED: 05/11 0/22 017 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 550 OLD CRYSTAL BAY RD N <br /> PIN : 33-118-23-13-0021 <br /> LEGAL DESC : CRYSTAL BAY BUSINESS CENTER 2ND ADD <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : COMMERCIAL-BUSINESS <br /> CONSTRUCTION TYPE : BACKFLOW DEVICE/TESTING/REPAIR <br /> NOTE: PERMIT FOR EXISTING BACKFLOW PREVENTORS AND REBUILDS ONLY <br /> APPLICANT BACKFLOW PREVENTER TESTING/REPAIR 10.00 <br /> STATE SURCHARGE FLAT-ADDITIONAL 1.00 <br /> CITY VIEW PLUMBING&HEATING MAIL-IN FEE 2.00 <br /> 1880-B WAYZATA BLVD W <br /> P.O.BOX 150 TOTAL 13.00 <br /> LONG LAKE,MN 55356 Payment(s) <br /> (952)473-8793 CHECK 37022 13.00 <br /> Minnesota State License#:plbg-MB005208 <br /> OWNER <br /> JEM Tech <br /> 550 OLD CRYSTAL BAY RD N <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 /> Applicant Permitee Signature Date Issued By Signature Date <br />