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CITY OF ORONO * Z 0 1 6 — P1 0 1 6 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 02/16/2016 <br /> ORONO, MN 55356- <br /> �^ (952) 249-4600 FAX: (952) 249-4616 <br /> ADQitESS : 1205 SHORELINE DR <br /> PIN : 02-117-23-43-0015 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0397 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> NOTE: REPLACE WATER HEATER <br /> VALUATION OF PLUMBING 0 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 0.03 <br /> APPLIANCE CONNECTIONS, INC. MAIL-IN FEE 2.00 <br /> 12850 CHESTNUT BLVD <br /> SHAKOPEE,MN 55379- TOTAL 52.03 <br /> (952)445-4803 Payment(s) <br /> Minnesota State License#:mech-MB004165 CHECK 7942 52.03 <br /> OWNER <br /> JACKLEY ET AL,JAY M <br /> 1205 SHORELINE DR <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORIv STATEMENT <br /> The work Yor 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 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 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 <br /> revoked at any time for due cause. � /�j, � <br /> � <br /> �`��_ ���.��� � � '�� C � � �� �—? � I/� � - <br /> ,_�j, �� <br /> Applicant Permitee Signature Date Issued By Signature Date <br />