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CITY OF ORONO PERMIT NO.: 2009-00390 <br /> , 2750 KELLEY PARKWAY <br /> � <br /> ORONO, MN 55356- DATE ISSUED: 07/08/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3060 FARVIEW LA <br /> PIN : 04-117-23-34-0014 <br /> LEGAL DESC : FARVIEW <br /> : LOT 004 BLOCK 002 <br /> NERMIT TYPE : PLUMBING (<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: INSTALLING A BACKFLOW PREVENTOR <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> REGENCY PLUMBING INC. STATE SURCHARGE PLBG(<$500) 0.50 <br /> 3414 LOUISIANA AVENUE N. <br /> CRYSTAL, MN 55427 TOTAL 15.50 <br /> (763)531-1855 <br /> OWNER <br /> HAFSTAD, B FLYGENRING &V <br /> 3060 FARVIEW LA <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORN STATEMENT <br /> I�hc work for which this permit is issucd shall be performed according to <br /> thc approved plans and specifications,applicable City approvals,and the <br /> State Buiiding Code. This permit is for only the work described and does <br /> no[gran[permission for additional or related work which requires separate <br /> pennits. AII 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[he 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 /> rev for due cause. �.� `C� <br /> J / � / Q � ._� � _ � <br /> � cant Pe itee Signature Date �—'�_ ����1��t f 7 / / <br /> Issued By Si ature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />