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� • CITY OF ORONO * z 0 1 4 - 0 1 4 0 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 12/08/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2680 PHEASANT RD <br /> PIN : 21-117-23-23-0020 <br /> LEGAL DESC : PHEASANT LAWN <br /> : LOT 020 BLOCK 000 <br /> PERMIT TYPE : PLUMBING (>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES- MULTIPLE <br /> NOTF,: 2 WATER CLOSETS,3 LAVAI�ORIF,S, 1 E3ATH"[�UB,2 SHOWERS <br /> VALUATION OF PLUMBING 3500 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG (VALUATION) 1.75 <br /> SANTEMA PLUMBING, INC. TOTAL S1.75 <br /> 4407 LOCKE AVE SW Payment(s) <br /> COKATO, MN 55321 CREDIT CARD 4719 51.75 <br /> �) <br /> Minnesota State License#: BUIL-004065PM <br /> OWIYER <br /> DOLLIFF, MATTNEW& KATHY <br /> 2680 PHEASANT RD <br /> EXCELSIOR, MN 55331- <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 deseribed 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 speciYied 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 applican[is responsible for assuring all required inspections are <br /> requested in confonnance with the State Building Code.This permit may be � <br /> revoked at any time for due cause. <br /> /"_� <br /> �', �5\Y Y �' l� � ! <br /> �-.�.... ��---- � o <br /> � '� ��--�--i� %.�-�'''/5/ / / <br /> Applicant Permitee Signature Date � Issued By Signaturc Date <br />