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{ , . CITY OF ORONO * 2 0 1 6 - 0 1 4 6 2 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: l U22/2016 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 2308 SHADYWOOD RD <br /> PIN : 17-117-23-44-0106 <br /> LEGAL DESC : WILEYS NAVARRE ADDN LAKE MTKA <br /> : LOT 014 BLOCK 000 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> NOTE: WATER HEATER REPLACEMENT <br /> VALUATION OF PLUMBING 1000 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> CHAMPION PLUMBING LLC STATE SURCHARGE PLBG(VALUATION) 1.00 <br /> 3670 DODD ROAD-SUITE 100 1VI�►IL-IN FEE 2.00 <br /> EAGAN,MN 55123- TOTAL 53.00 <br /> �� Payment(s) <br /> Minnesota State License#:plbg-PC000308,mech-MB005365 CHECK 33700 53.00 <br /> OW1�1ER <br /> STASKE,ELIZABETH <br /> 2308 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 pertnit is for only the work described and does <br /> not grant permission for additional or related work which requires separate <br /> permiu. All provisions of laws and ordinances goveming this rype 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 l80 days at any time after work has commenced. <br /> The applicant is responsible for assuring all required inspections aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. _ <br /> � � �� i�y �� <br /> Applicant Permrtee Signature Date Iss e Signature Date <br />