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G � w <br /> CITY OF ORONO * z 0 1 3 - 0 1 z 3 0 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 1U20/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1100 MILLSTON RD <br /> PIN : 10-117-23-14-0015 <br /> LEGAL DESC : MILLSTON <br /> : LOT 000 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: AREA DRAINS GARAGE <br /> VALUATION OF PLUMBING 2400 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> RIVERSIDE MECHAMCAL STATE SURCHARGE PLBG (VALUATION) 120 <br /> 12460 ZINRAN AVENUE <br /> SAVAGE,MN 55378- MAIL-IN FEE 2.00 <br /> Minnesota State License#: PC644809 TOTAL 53.20 <br /> PAID WITH CC# 5399 <br /> OWNER <br /> BURWELL, MR. &MRS. RODNEY P <br /> 1100 MILLSTON ROAD <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> l he work for which this permit is issued shall be performed according to <br /> die approvcd 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due caus . <br /> �vLt�c�� ��i a� i�3 , �L �.� ���Zt�z �� i o7�i �� <br /> Applicant Permitee Signature Date Issue � y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />