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PERMIT <br /> CITY OI ORONO Permit Number: <br /> 2750 Kelley Parkway - PO Box 66 Posos2 <br /> Crystal Bay, Minnesota 55323 Permit Type: FiXtures <br /> (952) 249-4600 Date Issued: 4i16�2o02 <br /> SITE ADDRESS: 2760 Countryside Dr W <br /> L.ong Lake,MN 55356 <br /> PID: o4-i i�-23-i2-ool i <br /> DESCRIPTION: <br /> Proposed Use: Kesidential <br /> Permit Class: Plumbing <br /> Permit Type: Fixtures Permit Sub-type(s): Multiple Fixtures <br /> DETAILS: <br /> Approved per resolution#: <br /> Separate pernuts required: <br /> NOTICES/REMARKS: <br /> FEE SUMMARY: Permit Fee: $ 62.50 Valuation: $ 5,000.00 <br /> State Surcharge Fee: $ 2.50 <br /> TOTAL FEE: $ 65.00 <br /> APPLICANT: Groth Water& Sewer OWNER: 1on&Molly Stern <br /> 775 Tower Drive 2760 Countryside Dr W <br /> Hamel,MN 55340 Long Lake,MN 55356 <br /> THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED <br /> AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND SfATE OF <br /> MINNESOTA BUILDING CODE REQUIREMENTS. <br /> j_ <br /> � �� _ � � <br /> ��G� �,,, r� � �-� �' � ���� ,�,� <br /> APPLICANT PE ITEE S[GNATURE ISSUED BY SIGNATURE <br /> Copies: 1-File(SiQnitures Required), 1-Apolicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1 <br />