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CITY OF ORONO �0 1 6 - 0 0 7 7 0 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/OU2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2515 COUNTRYSIDE DR <br /> PIN : 04-]17-23-]1-0007 <br /> LEGAL DESC : COUNTRYSIDE MANOR <br /> : LOT 003 BLOCK 002 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> NOTE: REPLACEMENT OF WATER HEATER <br /> VALUATION OF PLUMBING 950 <br /> APPLICAIVT PLUMBING F[XTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 1.00 <br /> CHAMPION PLUMBING LLC MAIL-IN FEE 2.00 <br /> 3670 DODD ROAD-SU[TE 100 <br /> EAGAN, MN 55123- TOTAL 53.00 <br /> �� Payment(s) <br /> Minnesota State License#:plbg-PC000308,mech-MB005365 CHECK 33022 53.00 <br /> OWNER <br /> DELANGE, LEON&CONSTANCE <br /> 2515 COUNTRYSIDE DR <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 perniission 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 noc <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 aRer 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 /> �l 4� � � � � � <br /> Applicant Permitee Signature Date Is ue B Signature Date <br />