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. CITY OF ORONO * z 0 1 z - 0 0 7 8 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 08/13/2012 <br /> x ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 245 FERNDALE RD N <br /> PIN : 36-118-23-41-0004 <br /> LEGAL DESC : UNPLATTED 36 1 18 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> APPLIANCE CONNECTIONS STATE SURCHARGE PLBG(<$500) 5.00 <br /> 1313 DANITA CR. MAIL-IN FEE 2.00 <br /> SHAKOPEE, MN 55379 <br /> (952)445-4803 M[SC FEE 0.00 <br /> Minnesota State License#: 057209PM TOTAL 22.00 <br /> OWIVER <br /> BECKSTROM, DARRELL& KENWYN <br /> 245 FERNDALE RD N <br /> WAYZATA, MN 55391 <br /> AGREEMENT AIVD SWORN STATEMENT <br /> The work for which this permit is issucd shall be performed according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> State Building Code. This permit is for only thc work describcd and does <br /> not grant pennission 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 not <br /> commenced within I80 days of the date of issuance,or if construction is <br /> suspended for a period ot�180 days at any time atter work has commenced. <br /> 'l�he 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 caus�e. <br /> `� (/I�- / / / / <br /> Applicanl Perrnitee Signature Date [ssucd By i nature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO . <br />