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� • CITY OF ORONO * 2 0 1 3 — 0 1 Z 6 1 * <br /> 2750 KELLEY PARKWAY �ATE [ssuEu: 12/03/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2590 COUNTRYSIDE DR <br /> PIN : 04-117-23-1]-0010 <br /> LEGAL DESC : COUNTRYSIDE MANOR 2ND ADDN <br /> : LOT 002 BLOCK 002 <br /> PERMIT TYPE : PLUMBING (<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> � . <br /> APPLICANT PLUMB[NG FIXTURE FEE(<$500) I5.00 <br /> BAX"I�ER MECHANICAL STATE SURCHARGE PLBG (<$500) 5.00 <br /> PO BOX 591 <br /> ELK RNER, MN 55330- MAIL-IN FEE 2.00 <br /> (612)227-6710 TOTAL 22.00 <br /> Minnesota State License #: 066036 PM <br /> OWNER <br /> FITLD, JAMES&CHR1S"C[NE <br /> 2590 COUNTRYSIDE DR <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> i�he N�urk fur���hich this perniit is issued shall be performed according to <br /> the approved plans and specifications,applicablc City approvals,and the <br /> State f3uilding Code. 'l�his permit is for only the work described and does <br /> not grant permission for additional or related work which requirrs separate <br /> permits All provisions of laws and ordinances govcming this typc of work <br /> shall be compicd H�ith�a�hether or not specitied herein.'fhis permit will <br /> expim and become null and void if construction aud�onzed is not <br /> commenced within 180 davs of the date of issuance,or if construction is <br /> suspended for a period ot� 180 days at any time after work has commenced. <br /> l�he applicant is responsible for assuring all rcquired inspections are <br /> requcsted in conformance with the State Building Code.This pennit may be <br /> revoked at anv time for due cause- <br /> 1���'.r' _" � � / / <br /> Applicant Permitee Signature Date Issucd I3v Si ature Date <br /> SEPARATE PERMI"I'S REQUIRED FOR WORK OTHER THAN DESCRIBED AB E. <br />