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CITY OF ORONO * z 0 1 2 - 0 0 z z 4 * <br /> � � 2750 KELLEY PARKWAY DATE ISSUED: 03/26/2012 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2990 SOMERSET LA <br /> PIN : 04-117-23-21-0011 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD 2ND ADDN <br /> : LOT 004 BLOCK 003 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> APPLIANCE CONNECTIONS STATE SURCHARGE PLBG(<$500) 5.00 <br /> 1313 DANITA CR. <br /> SHAKOPEE,MN 55379 MAIL-IN FEE 2.00 <br /> (952)445-4803 MISC FEE 0.00 <br /> Minnesota State License#:057209PM TOTAL 22.00 <br /> OWNER <br /> BUNDY,MICHAEL <br /> 2990 SOMERSET LA <br /> LONG LAKE,MN 55356- <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 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 /> / / � <br /> Applicant Permitee Signature Date Issued By i nature <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER HAN DESCRIBED ABO . <br />