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t � <br /> CITY OF ORONO * z 0 1 7 - 0 0 3 1 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 04/03/2017 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2800 SHADYWOOD RD <br /> p�� : 21-117-23-13-0023 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1196 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : WATER METER-RESIDENTIAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER METER-RESIDENTIAL <br /> NOTE: INSEPCTIONS ARE DONE BY PUBLIC WORKS DEPARTMENT. <br /> TO SET-UP AN INSPECTION,PLEASE CALL:(952)249-4613 <br /> 1"NEPTUNE WATER METER <br /> ERH#1541506626 <br /> SERIAL 52648030 <br /> WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1 <br /> APPLICANT WATER METER RESIDENTIAL 372.06 <br /> WATER METER RESIDENTIAL HORN 144.64 <br /> COX PLUMBING LLC TOTAL 516.70 <br /> 17041 172ND AVE SE Payment(s) <br /> BIG LAKE, MN 55309- CHECK 6446 516.70 <br /> (612)242-9247 <br /> Minnesota State License#: plbg-PC644119 <br /> OWNER <br /> BERGH, HANS&SHARON <br /> 2800 SHADYWOOD RD <br /> EXCELSIOR, MN 55331- <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 Ciry 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 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 I80 days of the date of issuance,or if construction is <br /> suspended for a period of l80 days at any time afrer 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 /> /� -3-�'r �� � , 3 ,�� <br /> y <br /> Applica Permitee Signature Date Issued By gnature Date <br />