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CITY OF ORONO <br /> * 20 II i -Ia a 4 I 7 I* <br /> 2750 KELLEY PARKWAY DATE ISSUED: 04/13/2018 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 190 CYGNET PL <br /> PIN : 04-117-23-22-0021 <br /> LEGAL DESC : SWAN LAKE ADDN <br /> : LOT 004 BLOCK 003 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: (1)WATER CLOSET <br /> (1)LAVATORY <br /> (1)BATHTUB <br /> VALUATION OF PLUMBING 1500 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 0.75 <br /> BROLL INC TOTAL 50.75 <br /> 7317 64TH AVE N Payment(s) <br /> BROOKLYN PARK,MN 55428- CHECK 1498 50.75 <br /> (612)251-6029 <br /> Minnesota State License#:plbg-PC644530 <br /> OWNER <br /> FREEMAN,MR.&MRS. <br /> 190 CYGNET PL <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 /> 7/3/ l4e0 /-1 fir) 9/ 1 3/ /3 <br /> Applicant Pe itee Signature Date Issued B ignature Date <br />