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CITY OF ORONO I I I II II I III IIII III III IIII I I IIII 111111 <br /> * 201S - 00169 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 02/10/2015 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 225 WILLOW DR N <br /> PIN : 33-118-23-41-0003 <br /> LEGAL DESC : UNPLATTED 33 118 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> STATE SURCHARGE PLBG(<$500) 5.00 <br /> APPLIANCE CONNECTIONS,INC. MAIL-IN FEE 2.00 <br /> 12850 CHESTNUT BLVD <br /> SHAKOPEE,MN 55379- TOTAL 22.00 <br /> (952)445-4803 Payment(s) <br /> Minnesota State License#: mech-MB004165 CHECK 6123 22.00 <br /> OWNER <br /> DILLMAN,JAMES <br /> 225 WILLOW DR 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 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 /> Applicant Permi a ignature Date Issued By Signature Date <br />