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� CITY OF ORONO * 2 0 1 5 - 0 0 8 6 7 * <br /> ' 2'750 KELLEY PARKWAY DATE ISSUED: 07/14/2015 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3359 CRYSTAL BAY RD <br /> PIN : 17-117-23-41-0025 <br /> LEGAL DESC : WALLACES ADDN TO V[L OF MTKA B <br /> : LOT 012 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCT[ON TYPE : WATER HEATER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> STATE SURCHARGE PLBG(<$500) 1.00 <br /> APPLIANCE CONNECTIONS, INC. MAIL-IN FEE 2.00 <br /> 12850 CHESTNUT BLVD <br /> SHAKOPEE, MN 55379- TOTAL 18.00 <br /> (952)445-4803 Payment(s) <br /> Minnesota State License#: mech-MB004165 CHECK 6523 18.00 <br /> OWNER <br /> LUZAICH, RICK <br /> 3359 CRYSTAL BAY RD <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 Ihe work described and does <br /> not grant permission for additional or related work which requires sepazate <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 I80 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 5tate Building Code.This permit may be <br /> revoked at any time for due cause. <br /> �� ��l'�' _ <br /> ► ' 1 C�1,1 � �;t,� f' � �...(�Q...� � � 1 �� (S <br /> Applicant Permitee Signature Date Issued By Sign re Date <br />