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, CITY OF ORONO * Z 0 1 5 - 0 0 8 3 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/30/2015 <br /> ' ORONO, MN 55356- <br /> (952) 249-4600 FAX: 952) 249-4616 <br /> ADDRESS : 1675 SHADYWOOD RD <br /> PIN : 17-117-23-21-0004 <br /> LEGAL DESC : MAPLEGATE INLET <br /> : LOT 003 BLOCK 002 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> STATE SURCHARGE PLBG(<$500) 5.00 <br /> CHAMP[ON PLUMBING LLC MAIL-IN FEE 2.00 <br /> 3670 DODD ROAD- SUITE 100 <br /> EAGAN, MN 55123- TOTAL 22.00 <br /> �� Payment(s) <br /> CHECK 31218 22.00 <br /> OWNER <br /> ZJAWIONY ETAL,BRIAN <br /> 1675 SHADYWOOD 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 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 /> requested in conformance with the State Building Code.This permit may be i� <br /> revoked at any time for due cause. . �� f <br /> < <br /> .. ' � `- <br /> � � ' � <br /> �� ����� ( �; �,, _' . � c� , � <br /> � <br /> -� - <br /> \ 1 Cc�l <<- �r- , =;c, � � <br /> Applicant Permitee Signature Date Issued By Signature �� Date <br />