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` A CITY OF ORONO * 2 0 1 4 - 0 0 3 3 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 04/18/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2629 CASCADE LA <br /> PIN : 33-118-23-11-0114 <br /> LEGAL DESC : STONEBAY FIFTH ADDITION <br /> : LOT 004 BLOCK 001 <br /> PERMIT TYPE : SEWER& WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NO"I�I�:: WA"fER �c SI:WER CONNECf10N <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> T& J CONCRETE WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> 9100 BALTIMORE STREET NE STATE SURCHARGE SEWER& WATER 5.00 <br /> BLAINE, MN 55449- TOTAL 105.00 <br /> (763)413-0988 Payment(s) <br /> Minnesota State License #: SW-646112 CHECK 12865 ]05.00 <br /> OWNER <br /> BUILDERS LLC, STONEBAY <br /> 14870 BROCKTON LANE <br /> PLYMOUTH, MN 55446- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specitications,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 /> perntits. 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 /> requcsted in conformance with thc State Building Code.This permit may be <br /> revoked at any time for due causc. <br /> ,��.,6 �3.�� y� ��� , s!/ <br /> Applicant Permitee Signature Date Iss � F3y Signature Date <br />