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CITY OF ORONO * Z 0 1 5 — 0 0 9 1 3 * <br /> �,, 2750 KELLEY PARKWAY DATE ISSUED: 07/2U2015 <br /> � ORONO, MN 55356— <br /> 952 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2755 ETHEL AVE <br /> PIN : 20-117-23-24-0017 <br /> LECAL DESC : CASCO HEIGHTS <br /> : LOT 006 BLOCK 003 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> APPLICAIYT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> TUMA CONSTRUCTION STATE SURCHARGE SEWER&WATER 1.00 <br /> 5045 COUNTY ROAD 19 <br /> M[NNETR[STA, MN 55359- TOTAL 101.00 <br /> (763)479-2982 Payment(s) <br /> Minnesota State License#: BUIL-PB695614 CHECK 4664 ]01.00 <br /> OWNER <br /> Everlast Enterprises, Inc. <br /> CLEARY,JAMES <br /> 4109 NORTH SHORE DR <br /> MOUND, MN 55364- <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 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. AII provisions of laws and ordinances goveming 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 au[horized is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of 180 day at any tim e has commenced. <br /> The applican s espons e r assuring a equired inspections are <br /> requested i c form e w� the Stat uy}ding Code.This permit may be <br /> revoked a time r du cause. � <br /> t, /� � sL-t-S� �7 i�t i ( 5 <br /> Ap 'cant Permitee Signature Date [ssued By Signature Date <br />