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I <br /> � CITY OF ORONO * z 0 1 z - 0 1 1 9 * <br /> , 2750 KELLEY PARKWAY DATE ISSUED: 1U2U201�2 <br /> ` ORONO,MN 55356- <br /> (952) 249-4600 FAX: .(952)249-4616 � <br /> ADDRESS : 3155 JAMESTOWN RD <br /> PIN : 28-11!8-23-33-0012 <br /> LEGAL DESC : CAMELOT <br /> : LOTi 001 BLOCK 001 <br /> PERMIT TYPE : PLLIMBING(>$500) I <br /> PROPERTY TYPE : RE3IDENTIAL <br /> CONSTRUCTION TYPE : FIJ�TURES-MULTIPLE <br /> NOTE: KITCHEN SINK-(2) <br /> DISPOSAL-(1) <br /> DISHWASHER-(1) <br /> VALUATION OF PLUMBING 2500 ' <br /> i <br /> i <br /> � <br /> � <br /> i <br /> APPL CANT PLUMBING FIXTURE FEE 50.00 <br /> FREEDOM MECHANICAL STATE SURCHARGE PLBG(VALUATION) 1.25 <br /> 8382 172ND AVE SE <br /> BECKER,MN 55308- TOTAL i 51.25 <br /> (612)363-6190 <br /> Minnesota State License#: (�04042PM <br /> i <br /> NER � <br /> DECUBELLIS,KENNET &JENNIFER � <br /> 3155 JAMESTOWN RD i <br /> LONG LAKE,MN 55356+ <br /> i <br /> i <br /> AGREEMENT A�TD SWORN STATEMENT <br /> The work for which this perm�t is issued shall be performed according to � <br /> the approved plans and speci�ations,applicable City approvals,and the <br /> State Building Code. This pe it is for only the work described and does <br /> not grant permission for addi ional or related work which requires separate <br /> permits. All provisions of la�s and ordinances governing this type of work � <br /> shall be compied with whet r or not specified herein.This permit will � <br /> expire and become null and�oid if construction authorized is not <br /> commenced within 180 day$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 responsiblt for assuring all required inspections aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at an e f due,c�ause/ <br /> i�i'i���%�C� // l 7/l !-2 /� l 2/ l/ Z.- <br /> Applicant Permitee Signature Date Is u By Signature Date <br /> SEPARATE PERMITS RFQUIRED FOR WORK OTHER THAN DESCRIBED ABO E. <br />