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CITY OF ORONO * z 0 1 5 - 0 1 t�� <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 08/12/2015 <br /> ORONO, MN 55356- <br /> � 952 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1165 FERNDALE RD W <br /> PIIY : 02-117-23-43-0026 <br /> LEGAL DESC : NORTH SHORE COTTAGE ACRES LAKE <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES- MULTIPLE <br /> NOTE: LANDRY TRAY REPLACEMENT&WATER HEATER REPLACEMENT <br /> VALUATION OF PLUMBING 4000 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 2.00 <br /> GRABOW PLUMBING, INC. TOTAL 52.00 <br /> 8420 REDWOOD STREET <br /> COON RAPIDS,MN 55433 Payment(s) <br /> CHECK 15446 52.00 <br /> 0 <br /> Minnesota State License#: plbg-643224,mech-004335 <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 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 sepazate <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 I80 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 inspec[ions aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> ' -, � � � z �S <br /> �/`�w�� - �r � �_ / �� � � ,� �.�--i-�� � � <br /> Applicant Permitee Signature Date Issued By Si ature Date <br />