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CITY OF ORONO * 2 0 1 6 - 0 1 2 3 4 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 09/29/2016 <br /> �' ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 60 SMITH AVE <br /> PIN : 02-117-23-21-0003 <br /> LEGAL DESC : ORONO ORCHARDS <br /> : LOT 041 BLOCK 000 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: VACUUM BREAKER FOR IRRIGATION SYSTEM <br /> VALUATION OF PLUMBING 500 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> THARALDSON PLUMBING STATE SURCHARGE PLBG(VALUATION) 0.25 <br /> 5680 MANITOU RD TOTAL 50.25 <br /> SHOREWOOD,MN 55331- P$yment(s) <br /> (952)4747400 CHECK 5861 50.25 <br /> Minnesota State License#:plbg-PC675647 <br /> OW1�iER <br /> MILLER,ROBERT <br /> 60 SMITH AVE <br /> WAYZATA,MN 55391- <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 Ciry approvals,and the <br /> State Building Code. This permit is for only the work described and dces <br /> not grant permission for additionai or related work which requires separate <br /> pertnits. All provisions of laws and ordinances goveming this rype 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 l SO 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 an time for due cause. <br /> i <br /> � � � 2`1� �-(� <br /> Applicant Permitee Signa ure Date Issued By 'gnature Date <br />