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� 4 CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 4 - 0 0 2 7 5 * <br /> DATE ISSUED: 04/03/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 140 BROWN RD S <br /> PIN : 03-117-23-12-0011 <br /> LEGAL DESC : KALLESTAD ACRES <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : PLUMBING (<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES- MULTIPLE <br /> NOTE: RBPLACE WATER HEATER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> STATE SURCHARGE PLBG(<$500) 5.00 <br /> APPLIANCE CONNECTIONS 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#: BUIL-057209PM CHECK 21120 22.00 <br /> OWNER <br /> COLEMAN, MR. & MRS. <br /> 140 BROWN RD S <br /> LONG LAKE, MN 55356- <br /> AGREEMEIVT AND SWORN STATEMENT <br /> The work for which this pem�it is issucd shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. "I'his permit is for only the work described and docs <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing[his type of work <br /> shall be compied with whether or not specitied hereia This pennit 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[ime after work has commenced. <br /> i�he applicant is responsible for assuring all required inspections are <br /> reques[ed in conformance with the S[ate Building Code.This permit may be <br /> revoked at any time for due cause. <br /> ��2�c..A;t�C�.—� `��3�5� Clit'L— �l � l / <br /> Applicant Permitee Signature Date �� Issu By Signature Date <br />