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III 1111 III 11 II II I I I II 11 <br /> CITY OF ORONO <br /> * 20 1 3 - 00 5 9 4 <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/01/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 50 WEAR LA <br /> PIN : 04-117-23-21-0006 <br /> LEGAL DESC : ROLLING MEADOWS <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> NOTE: WATER HEATER REPLACEMENT <br /> APPLICANT MECHANICAL(<$500) 15.00 <br /> CHAMPION PLUMBING LLC STATE SURCHARGE MECH(<$500) 5.00 <br /> 3670 DODD ROAD- SUITE 100 <br /> EAGAN,MN 55123- MAIL-IN FEE 2.00 <br /> () TOTAL 22.00 <br /> OWNER <br /> HILL,DAVID&JEANETTE <br /> 50 WEAR LA <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 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. <br /> / 6144_ "\... i <br /> Applicant Permitee Signature Date ssue y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />