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t 1 <br /> � CITY OF ORONO * 2 0 1 2 — PJ fd 9 1 2 * <br /> 2750 KELLEY PARKWAY DATE ISSUEU: 09/12/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3340 GRAHAM HILL RD <br /> PIN : OS-117-23-11-OO12 <br /> LEGAL DESC : GRAHAM HILL PRESERVE 2 <br /> : LOT 4 BLOCK 2 <br /> NERMIT TYPE : PLUMBING (<$500) <br /> PROPERTY TYPE : RESIDENTiAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NO"I�L: WA"I�I?R SOFTEN[?R <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> RICHARD'S CUSTOM WATER STATE SURCHARGE PLBG (<$500) 5.00 <br /> 6121 EXCELSIOR BLVD. #206 <br /> ST. LOUIS PARK, MN 55416- TOTAL 20.00 <br /> (952)920-1200 <br /> Minnesota State License#: WM061456 <br /> OWNER <br /> MCCARTY, LEROY& LISA <br /> 3340 GRAHAM HILL ROAD <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issucd shall bc performed accordine to <br /> the approved plans and specitications,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 /> pennits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specified hercin.This permit will <br /> e�pire and become null and void if construction authorized is not <br /> commenced wi[hin 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 re onsible for assuring all required inspections are <br /> requested in co mance with the State Building Code.This permit may be <br /> revoked at ime fo c ca <br /> �l i2/ �2 ��-�. � �l/ 2--//y. <br /> plicant P i Signature Date Issued Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />