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r � <br />» CITY OF ORONO * 2 0 1 3 - 0 0 6 7 5 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/18/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952 249-4616 <br /> ADDRESS : 495 OXFORD RD <br /> PIN : OS-117-23-41-0011 <br /> LEGAL DESC : STIELOWS ADDN <br /> : LOT 003 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: WATER SOFTENER <br /> VALUATION OF PLUMBING 600 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> RICHARD'S CUSTOM WATER STATE SURCHARGE PLBG(VALUATION) 0.30 <br /> 6121 EXCELSIOR BLVD.#206 <br /> ST. LOUIS PARK, MN 55416- TOTAL 50.30 <br /> (952)920-1200 <br /> Minnesota State License#: WM061456 <br /> OWNER <br /> SAMPLE,MIKE&ANNE <br /> 1449 BAY RIDGE RD <br /> WAYZATA, MN 55391- <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 goveming this type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become null and oid if construction authorized is not <br /> commenced within I SO of the date of issuance,or if construction is <br /> suspended for a perio 80 days at any time after work has commenced. <br /> The applicant is re sible for as g all required inspections are <br /> requested in co ce t e Building Code.This permit may be <br /> revoked at e d cau . �/��'l� <br /> l/ l � J i l�i / <br /> Applicant P it ign e Date ssue y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK O ER THAN DESCRIBED ABOVE. <br />