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CITY OF ORONO * 2 0 1 4 - PJ 0 9 9 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/03/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2630 COUNTRYSIDE UR W <br /> PIN : 04-] 17-23-12-0015 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 007 BLOCK 002 <br /> PERMIT TYPE : PLUMBING (>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES- MULTIPLE <br /> NO�CE: PLUMBING f�IXI�URES: (1)KITCHEN SINK,(1)UISPOSAL,(1)DISHWASHER.(1)LnUNDRY TRAY AND(1)WASHER <br /> VALUATION OF PLUMBING 3600 <br /> APPLICANT PLUMBING F[X�'URE FF,F 50.00 <br /> PROMECH L(.0 STATE SURCHARGE PLBG (VALUATION) 1.80 <br /> 121]0 IDAHO AVE N TOTAL 51.80 <br /> CHAMPL[N, MN 55316- Payment(s) <br /> (612) 518-3066 CHECK 7956 51.80 <br /> OWNER <br /> URNESS, TODD& KATHERINE <br /> 2630 COUNTRYSIDE DR W <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORN STATF.MENT <br /> l�he 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. "I�his pennit is for only thc work dcscribed 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 da��s at any time afrer work has commenccd. <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 /> �/} �� �� Yfit-� /' l �l l <br /> lic Permitee Signature Date Issu d By Signature Date <br />