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CITY OF ORONO PERMIT NO.: 2011-00646 <br /> � 2750 KELLEY PARKWAY <br /> - ORONO, MN 55356- DATE IssuEn: 07/13/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 106 CHEVY CHASE DR <br /> PIN : 36-118-23-41-0033 <br /> LEGAL DESC : HILL O'WAY MANOR <br /> : LOT 028 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: 1STFLOOR:2 WC,3 LAV, 1 BA"CE�TUI3 <br /> VALUATION OF PLUMBING 1757 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> ATHENA CARE, INC. STATE SURCHARGE PLBG(VALUATION) 0.88 <br /> 4915 THOMAS AVE. S. <br /> MINNEAPOLIS, MN 55410- MAIL-IN FEE 2.00 <br /> (651)558-2564 0 1 0 1 MISC FEE 0.00 <br /> TOTAL 52.88 <br /> OWNER <br /> JOHNSON, MR. &MRS. <br /> 106 CHEVY CHASE DR <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this pennit is issued shall be performed according to <br /> thc approved plans and specifications,applicable City approvals,and thc <br /> State Building Code. This permit is for only the work described and docs <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 ca4se. <br /> ���'4�-� �t. / / / / <br /> Applicant Permitee Signature Date [ssued B ignature ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO . <br />