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� CITY OF ORONO PERMIT NO.: 2009-00703 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 10/13/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 567 PARK LA <br /> PIN : 06-117-23-41-0045 <br /> LEGAL DESC : MINNETONKA SUMMIT PARK <br /> : LOT O11 BLOCK 006 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: 1 LAV-STUB OUT <br /> 1 K[TCHEN SINK <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> PRESTHOLDT, PERRY STATE SURCHARGE PLBG(<$500) 0.50 <br /> 567 PARK LA TOTAL 15.50 <br /> LONG LAKE, MN 55356- <br /> OWNER <br /> PRESTHOLDT, PERRY <br /> 567 PARK LA <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 ar 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 /> request conformanc ith the State Building Code.This permit may be <br /> revoke at n time for ue cause. <br /> Y _._. <br /> � IQl � � l 0 / � <br /> A plicant Per itee Signature Date Issued By i nature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO . <br />