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t � <br /> CITY OF ORONO PERMIT NO.: 2009-00649 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 09/30/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 980 FERNDALE RD W <br /> PIN : 02-117-23-44-0019 <br /> LEGAL DESC : COUNTRY CLUB ESTATES <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES -MULT[PLE <br /> NO'CF.: PLUMBING F[XTURES-(1)KITCHEN SINK,(1)DISHWASI�ER,(1)SILLCOCK,AND(1)WASHER <br /> VALUATION OF PLUMBING 2500 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> SAFAR,JACK&PAMELA STATE SURCHARGE PLBG (VALUATION) 1.25 <br /> 980 FERNDALE RD W <br /> WAYZATA, MN 55391- TOTAL 51.25 <br /> OWNER <br /> SAFAR, JACK& PAMELA <br /> 980 FERNDALE RD W <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The�cork for���hich 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 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 specitied herein.This permit will <br /> expire and become n and void if construction authorized is not <br /> commenced withi 8 days of the date of issuancc,or if construction is <br /> suspended for cri d of 180 days at any time after work has commenced. <br /> The applica is r onsible for assuring all required inspections are <br /> requested� c o ance with the State Building Code.This permit may be <br /> revoke at t e for due cause. <br /> / / / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCR[BED ABOVE. <br />