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CITY OF ORONO * Z 0 1 5 - 0 1 5 0 4 * <br /> . <br /> 2750 KELLEY PARKWAY DATE ISSUED: i l/24/2015 <br /> ' ' ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 555 OXFORD RD <br /> PIN : OS-117-23-41-0024 <br /> LEGAL DESC : KLITZKE ADDN <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: WATER HEATER <br /> VALUATION OF PLUMBING 1700 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 0.85 <br /> BENJAMIN FRANKLIN PLUMBING MAIL-IN FEE 2.00 <br /> 5718 INTERNATIONAL PKWY <br /> NEW HOPE,MN 55428- TOTAL 52.85 <br /> (612)238-9709 Payment(s) <br /> Minnesota State License#:plbg-PC643703,mech-MB004722 CREDIT CARD 0169 52.85 <br /> OWNER <br /> KLITZKE,CORNELIA <br /> 555 OXFORD 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 dces <br /> not grant permission for additional or rela[ed 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 /> � <br /> �.� �/ ��.�-,�S <br /> Applicant Permitee Signature Date Issue Signature Date <br />