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� , CITY OF ORONO * 2 0 1 5 - 0 1 1 1 7 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/O1/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2560 KELLY AVE <br /> PIN : 20-117-23-11-0007 <br /> LEGAL DESC : REG. LAND SURVEY NO.0088 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: WATER&SEWER CONNECTION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> PROFESSIONAL GROUNDS MAINTENANCE STATE SURCHARGE SEWER&WATER 1.00 <br /> 1515 CONSTANCE BLVD NE <br /> HAM LAKE,MN 55304- MAIL-IN FEE 2.00 <br /> (763)434-3494 TOTAL 103.00 <br /> Minnesota State License#: PLUM-643761 Payment(s) <br /> CREDIT CARD 0386 103.00 <br /> OWNER <br /> International Ministerial Fellowshi <br /> P.O.BOX 100 <br /> NAVARRE,MN 55392- <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 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 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 for due cause. <br /> C � � P� � l � l� S <br /> Applicant Permitee Signature Date Issue Signature Date <br />