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f _ r CITY OF ORONO 11 1 II I 11 I Ir <br /> * <br /> 2750 KELLEY PARKWAY * 2 0 1 6 - 0 1 0 1 1 <br /> DATE ISSUED: 08/22/2016 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 540 OLD CRYSTAL BAY RD S <br /> PIN : 04-117-23-42.0023 <br /> LEGAL DESC : WHITE OAK OVERLOOK <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : RESIDENT <br /> CONSTRUCTION TYPE : FIXTURES- TIPLE <br /> NOTE: (1)WATER CLOSET,(1)LAVATORY,(1)IKITCHEN SINK,(1)WASHER <br /> VALUATION OF PLUMBING 3000 <br /> II <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 1.50 <br /> PLUMBING WEST,INC. MAIL-IN FEE 2.00 <br /> 23248 WALDEN AVENUE <br /> HUTCHINSON,MN 55350 TOTAL 53.50 <br /> (320)587-0300 Payment(s) <br /> CHECK 4696 53.50 <br /> OWNER <br /> ROGOSHESKE,GEORGE FUNK&JUDY <br /> 540 OLD CRYSTAL BAY RD S <br /> LONG LAKE,MN 55356- <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 separate <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 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 /> 6.744_42:44ecet) <br /> 1€15firg 67- <br /> Applicant Permitee Signature Date Issued BrSignature Date <br />