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CITY OF ORONO * 2 0 1 5 — 0 0 2 3 8 * <br /> •� 2750 KELLEY PARKWAY DATE ISSUED: 02/26/2015 <br /> - ORONO, MN 55356- <br /> (952) 249-4600 FAX: 952) 249-4616 <br /> ADDRESS : 113 CHEVY CHASE DR <br /> PIN : 36-118-23-41-0012 <br /> LEGAL DESC : HILL O'WAY MANOR <br /> : LOT 007 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTIOIv TYPE : WATER HEATER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> STATE SURCHARGE PLBG(<$500) 5.00 <br /> WELD& SONS PLUMBING CO INC. MAIL-IN FEE 2.00 <br /> 3410 KILMER LANE N <br /> PLYMOUTH,MN 55441- TOTAL 22.00 <br /> (763)475-0296 Payment(s) <br /> CHECK 10003 22.00 <br /> OWNER <br /> JAMSA, JONATHAN& MARTHA <br /> 113 CHEVY CHASE DR <br /> WAYZATA, MN 55391- <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[he work described and does <br /> no[grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing this[ype of work <br /> shall be compied with whether or not specified herein."Chis permi[will <br /> expire and become null and void if construction authorized is not <br /> commenced within l80 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 /> The applicant is responsible for assuring all required inspec[ions are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> f ,� a : �_ ; C � �� 2 � ��i / <br /> Applicant Permitee Signature Date Issued Signature Date <br />