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CITY OF ORONO <br /> . * 2 0 1 4 - 0 0 7 2 B * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/10/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952)249-4616 <br /> ADDRESS : 2605 KELLY AVE <br /> PIN : 20-117-23-14-0022 <br /> LEGAL DESC : TOWNSITE OF LANGDON PARK <br /> : LOT 005 BLOCK 005 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> VALUATION OF PLUMBING 41000 <br /> APPLICANT PLUMBING FIXTURE FEE 512.50 <br /> RIVERSIDE MECHANICAL STATE SURCHARGE PLBG(VALUATION) 20.50 <br /> 12460 ZINRAN AVENUE MAIL-IN FEE 2.00 <br /> SAVAGE,MN 55378- TOTAL 535.00 <br /> Minnesota State License#: plbg-PC644809,mech-MB650157 Payment(s) <br /> CHECK 3846 535.00 <br /> OWNER <br /> WINE, SCOTT&JILL <br /> 2587 KELLY AVE <br /> EXCELSIOR, MN 55331- <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 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 goveming 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> v /i� l l <br /> Applicant Permitee Signature Date Issued By iature Date <br />