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CITY OF ORONO * Z 0 1 3 - 0 0 7 3 0 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/29/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 140 CRYSTAL CREEK RD <br /> P[N : 33-118-23-33-0010 <br /> LEGAL DESC : CRYSTAL CREEK <br /> : LO"I' 004 BLOCK 002 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> APPLIANCE CONNECTIONS STATE SURCHARGE PLBG (<$500) 5.00 <br /> 12850 CHESTNUT BLVD <br /> SHAKOPEE, MN 55379 MAIL-IN FEE 2.00 <br /> (952)445-4803 TOTAL 22.00 <br /> Minnesota State License#: 057209PM <br /> OWNER <br /> BRODEN, DAVID& LAYLON <br /> 140 CRYSTAL CREEK RD <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORIY STATEMENT <br /> �he work for���hich this permit is issued shall be perfonned according ro <br /> die approved plans and specitications,applicable City approvals,and the <br /> State Building Code. This permit is fbr 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«�hether or not specified herein.'I'his 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 at[er work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in confbrmance with tke State Building Code.This permit may be <br /> revoked at any time fo�due cause. <br /> �/�v`'�."_� �il.�. l l l l <br /> Applicant Permitce Signature Date Issued By Si ure e <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER T AN DESCRIBED AB E. <br />