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CITY OF ORONO PERMIT NO.: 2010-00154 <br /> a 2750 KELLEY PARKWAY <br /> � " ORONO, MN 55356- �ATE Iss[1En: 03/17/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2695 COUNTRYS[DE DR W <br /> PIN : 04-117-23-13-0005 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 005 BLOCK 003 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENT[AL <br /> CONSTRUCTION TYPE : FIXTURES- MULTIPLE <br /> NOTE: 2ND FLOOR: I WC, 1 LAV, 1 TUB, 1 SHOWER <br /> VALUATION OF PLUMBING 5200 <br /> APPLICANT PLUMBING FIXTURE FEE 65.00 <br /> STEWART PLUMB[NG, [NC. STATE SURCHARGE PLBG(VALUATION) 2.60 <br /> 13025 GEORGE WEBER DR <br /> SUITE#1 MAIL-IN FEE 2.00 <br /> ROGERS, MN 55374 MISC FEE 0.00 <br /> (763)428-1833 TOTAL 69.60 <br /> OWNER <br /> PETERSON, DON <br /> 2695 COUNTRYSIDE DR W <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 sepazate <br /> permits. A11 provisions of Iaws and ordinances governing this type of work <br /> shaii 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 aYter 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 /> `��/��/l.�l.� "` � � l l <br /> Applicant Permitee Signature Date Issued By i nature ate <br /> SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED ABO <br />