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� � CITY OF ORONO PERMIT IYO.: 2009-00544 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 09/OU2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 4040 DAHL RD <br /> PIN : 07-117-23-11-0021 <br /> LEGAL DESC : PIRATES COVE <br /> : LOT 017 BLOCK 001 <br /> PERMIT TYPE : PLUMBING (>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : VACUUM BREAKER <br /> NOTE: INSTALL(1)RPZ <br /> APPLICAIYT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> NORTHSTAR MECHANICAL STATE SURCHARGE PLBG (<$500) 0.50 <br /> 30299 109TH AVE <br /> HANOVER, MN 55341- TOTAL 15.50 <br /> (763)498-0009 <br /> OWNER <br /> LEPPLA, MR& MRS JOHN <br /> 4040 DAHL RD <br /> MOUND, MN 55364 <br /> AGREEMENT AND SWORN STATEMENT <br /> The wark for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable Ciry 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 /> � /7 � C / � / �r <br /> / / <br /> ppl' nt r � ignat e Date Issued By Signature Date <br /> SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />