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¢ � CITY OF ORONO * 2 0 1 z — P1 0 z z 0 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 03/26/2012 <br /> � ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> REPRINTED ON 3/26/2012 <br /> ADDRESS : 2905 SIXTH AVE N <br /> PIN : 28-118-23-31-0006 <br /> LEGAL DESC : GARDEN GROVE <br /> : LOT 002 BLOCK 002 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> VALUATION OF PLUMBING 0 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> LEGACY MECH SERVICES STATE SURCHARGE PLBG(VALUATION) 5.00 <br /> 4 T t�{ cc1�d C-�a.� G� <br /> MONTICELLO,MN 55362- MAIL-IN FEE 2.00 <br /> (763)219-8978 MISC FEE 0.00 <br /> TOTAL 57.00 <br /> OWNER <br /> HAGEN&AGNETA TOTH,JEFFREY <br /> 2905 SIXTH AVE N <br /> LONG LAKE,MN 55356- <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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> / / / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />