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PERMIT <br /> CITY OF ORONO PERMIT TYPE: Fi t I tdici <br /> 2750 Kelley Parkway - P.O. Box 66 - :-: •- <br /> Crystal Bay, Minnesota 55323 Permit Number. <br /> (612) 473-7357 Date Issued: 0:3/i2/ '/ <br /> SITE ADDRESS: <br /> 79S OLD CRYSTAL BAY RD N <br /> jG <br /> PIN . : —23-2,4-0001 <br /> DESCRIPTION: <br /> 2 FIXTURES/1 GAS PIP <br /> R11.1mhing Fermi t. Type FIXTURES <br /> PUffilL7: Tic% WC)rk TYPE: I N•c_.:.T I TUT I Ors.J.Irsi <br /> K I TCHEN SIM< 2 UNDEF T NED <br /> REMARKS: <br /> TCH SINK 3RD FLOOR, 1)RAIN IN ROOM, 1 GAS PIPING IN SCIENCE ROOM <br /> FEE SUMMARY: <br /> VALUATION $1 , 500 <br /> Base F $2.5 . (K) <br /> rk r <br /> Surcharge <br /> Total Fee <br /> CONTRACTOR: _ , - Appi ir7tnt - OWNER: <br /> : 11 iEW LH 247:::S793 in HIAIH <br /> E.80 /17:' WAYZA If) Vi.) OLD CRY!::,TAL RAY RD N <br /> ION iK MN ORONO MN <br /> (613) 473-5793 <br /> THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS <br /> SPECIFIED AND AGREES TO DO ALL VORK IN STRICT COMPLIANCE V,TTH ALL#CITY OF * <br /> 'I:IRMO ORDINANCES AND STATE OF MINNESOTA SVILDINGf.,ccoe REQUTREMENTS. <br /> C. eiUtze svt-3}13- ,\* <br /> APPLICANT/PERMITEE IGNATURE ISSUED BY:SIGNATURE <br />