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CITY OF ORONO * Z 0 1 3 - 0 0 5 0 3 * <br /> ` 2750 KELLEY PARKWAY DATE ISSUED: 06/13/2013 <br /> ` ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2435 COUNTRYSIDE DR <br /> PIN : 04-117-23-11-0005 <br /> LEGAL DESC : COUNTRYSIDE MANOR <br /> : LOT 001 BLOCK 002 <br /> PERMIT TYPE : PLUMBING (> $500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : F[XTURES - MULTIPLE <br /> NOTE: BSMT: 1 WC, 1 LAV, 1 SHOWGR, I FLOOR DRAIT�' <br /> 1S�1'Fi,: 1 KITCHGN SINK, D[SPOSAL, 1 DISHWASIIER, 1 WASIIER <br /> 2ND FL: 1 WC, 1 LAV, ] TUB <br /> VALUATION OF PLUMBING 7200 <br /> APPLICANT <br /> PLUMBING FIXTURE FEE 90.00 <br /> MARK MAAS PLUMBING STATE SURCHARGE PLBG (VALUATION) 3.60 <br /> 1 1599 KRAMEL AVE NW <br /> ANNANDALE, MN 55302 MAIL-IN FEE � <br /> Minnesota State License#: PC643489 TOTAL /.� .,., <br /> PAID WITH CC# 6078 �360 <br /> OWNER <br /> FULLERTON &ANDRIA MOLDZIO, JOHN <br /> 2435 COUNTRYSIDE DR <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 E3uilding 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 la�vs and ordinances governing this type of work <br /> shall be eompied with whether or not specified herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within I80 days of the d�te 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 Yor assuri g all required inspections are <br /> requested in conformance w� c ate Building Code.This permit may be <br /> revoked at any tim for e ca <br /> ,G � / / / / <br /> App ic Per itee S gnature Date Issued By Sign re <br /> SEPARATE PERMITS REQ[1IRED FOR WORK OTHER TH N DESCRIBED ABO <br />