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�� CITY OF ORONO PERMIT NO.: 2010-00539 <br /> `� 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE IssuEn: 06/29/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2172 SHADYWOOD RD <br /> PIN : 17-117-23-42-0010 <br /> LEGAL DESC : WILEYS PARK LAKE MTKA <br /> : LOT 000 BLOCK 001 <br /> PERMIT TYPE : PLUMBING (>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: 4 WATER CLOSET,6 LAVATORY,3 BATHTUB, 1 SHOWER,2 KITCHEN SINK,2 DISPOSAL, 1 DISHWASHER,2 SILICOCKS, <br /> 1 FLOOR DRAIN, 1 LAUNDRY TUB, 1 WATER HEATER,2 WET BARS <br /> VALUATION OF PLUMBING 12000 <br /> APPLICANT PLUMBING FIXTURE FEE 150.00 <br /> AREA WIDE PLUMBING STATE SURCHARGE PLBG (VALUATION) 6.00 <br /> 9989 190TH ST. <br /> SILVER LAKE,MN 55381- TOTAL 156.00 <br /> (952)292-5297 <br /> Minnesota State License#: 61937- PM <br /> OWNER <br /> DORE, STEVEN <br /> 8351 WEST 109TH STREET <br /> BLOOMINGTON,MN 55438- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this pemiit is issued shall be performed according to <br /> the approved plans and specitications,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 /> reques[ed in conformance with e State Building Code.This permit may be f <br /> revoked at a2x due ause. c� <br /> �`�� G � z� � �� l����-� �`�'t�t� (� —Z�l 0 <br /> � � <br /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />