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� ��. <br /> CITY OF ORONO * z 0 1 6 - 0 0 0 8� <br /> 2750 KELLEY PARKWAY DATE ISSUED: OU26/2016 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 3640 JACOBS MILL RD <br /> PIN : 32-118-23-24-0010 <br /> LEGAL DESC : JACOBS MILL <br /> : LOT 004 BLOCK 001 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: (1)WATER CLOSET,(1)LAVATORY,(1)SHOWER,(1)DISHWASHER,(1)SILLCOCK,(1)WET BAR,(1)MISCELLANEOUS <br /> VALUATION OF PLUMBING 4100 <br /> APPLICANT PLUMBING FIXTURE FEE 51.25 <br /> STATE SURCHARGE PLBG(VALUATION) 2.05 <br /> SCHULTIES PLUMBING MAIL-IN FEE 2.00 <br /> 1521 94TH LANE NE <br /> BLAINE,MN 55449 TOTAL 55.30 <br /> (651)786-4007 Payment(s) <br /> Minnesota State License#:plbg-PC644177,mech-MB005379 CHECK 33529 55.30 <br /> OWNER <br /> HOFFMAN,KEITH&MARY � <br /> 3640 JACOBS MILL RD <br /> LONG LAKE,MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which[his 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 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 /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. ,. <br /> �_ ! / �[_-l� �� <br /> Applicant Permitee Signature Date Issued Signature Date <br />