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^ CITY OF ORONO PERMIT NO.: 2011-01089 <br /> . 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE IssuEn: 09/20/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 930 COX FARM RD <br /> PIN : 27-118-23-33-0013 <br /> LEGAL DESC : SHADOWOOD FARM <br /> : LOT O10 BLOCK 001 <br /> PERMIT TYPE : PLUMBING (>$500) <br /> PROPERTY TYPE : RESIDENT[AL <br /> CONSTRUCTION TYPE : FIXTURES- MULTIPLE <br /> NOTE: BASGMENT: 1 WC, 1 LAV, 1 SHOWGR, 1 KIT SINK, 1 D[SPOSAL, 1 DISHWASHER, 1 FLOOR DRAIN <br /> 1 ST FLOOR: 1 WC, 1 LAV, � <br /> VALUATION OF PLUMBING 6400 � <br /> APPLICANT PLUMBING FIXTURE FEE 80.00 <br /> NRH PLUMBING INC. <br /> 6460 153RD LN STATE SURCHARGE PLBG (VALUATION) 3.20 <br /> RAMSEY, MN 55303- TOTAL 83.20 <br /> (612)245-7280 <br /> Minnesota State License#: 067436 PM <br /> OWNER <br /> K[LLINGSTAD, MR. & MRS. <br /> 930 COX FARM 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 oniy the work described and does <br /> not grant permission for additional or rclated work which requires separate <br /> permits. All provisions of laws and ordinances goveming this type of work <br /> shall be compied wi[h 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 r uired inspections are <br /> requested in conformance wilh the St te B il ing Code.This permit may bc <br /> revoked at any ti e for due cause. � <br /> �� �� � l t ��7u�� <br /> � � <br /> Applicant Permitee Signature Date Issued ignature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB . <br />