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� CITY OF ORONO PERMTT NO.: 2010-00396 <br /> � 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUEn: OS/27/2010 <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 : SEWER& WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: WATER&SEWER DISCONNECT <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> AREA WIDE PLUMBING WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> 9989 190TH ST. STATE SURCHARGE SEWER&WATER 0.50 <br /> SILVER LAKE,MN 55381- <br /> (952)292-5297 TOTAL 100.50 <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 permit 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 afrer work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conforn}ance with the ate Building Code.This permit may be <br /> revo d at any tim r due cause <br /> �i l l �>�22�t-�- 5 /a 7//D <br /> Applicant Permitee Signature Date I ed By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />