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� CITY OF ORONO * z 0 1 5 - 0 0 0 1 z * <br /> f 2750 KELLEY PARKWAY DATE ISSUED: 01105/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: (952 249-4616 <br /> ADDRESS : 1165 FERNDALE RD W <br /> PIN : 02-117-23-43-0026 <br /> LEGAL DESC : NORTH SHORE COTTAGE ACRES LAKE <br /> : LOT 000 BLOCK 000 <br /> PERM[T TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES- MULTIPLE <br /> NOTE: 2 KITCHEN SINKS,2 DISPOSALS,2 D[SHWASHERS <br /> VALUATION OF PLUMBING 8500 <br /> APPLICANT PLUMB[NG FIXTURE FEE 106.25 <br /> STATE SURCHARGE PLBG (VALUATION) 4.25 <br /> SELECT MECHANICAL SERVICES INC. TOTAL 110.50 <br /> 6219 CAMBRIDGE ST Payment(s) <br /> ST. LOUIS PARK, MN 55416- CHECK 3814 110.50 <br /> (952)926-4488 <br /> OWNER <br /> BROOK, ROBERT <br /> 1165 FERNDALE RD W <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and speciYications,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 /> permi[s. 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 Yor d cause. <br /> � � , � /.� (�. f� 1 5 � � <br /> � 1�-�-� �� � � S <br /> Applicant Perm' ee Signature �Date� Issued By S gnature Date <br />