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• CITY OF ORONO * Z 0 1 5 — 0 0 5 7 6 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: OS/1 U2415 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 375 FERNDALE RD N <br /> PIN : 36-118-23-41-0003 <br /> LEGAL DESC : iJNPLATTED 36 118 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> STATE SURCHARGE PLBG(<$500) 5.00 <br /> CHAMPION PLUMBING LLC MAIL-IN FEE 2.00 <br /> 3670 DODD ROAD- SU[TE 100 TOTAL 22.00 <br /> EAGAN, MN 55123- Payment(s) <br /> �� CHECK 30945 22.00 <br /> OWNER <br /> CARLSON,MATTHEW& KALEENA <br /> 375 FERNDALE RD N <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 the work described and does <br /> not grant permission for additional or related work which requires sepazate <br /> permits. All provisions of laws and ordinances goveming 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 l80 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 State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> �'� <br /> � ��"1'Y�Cs`L'� � � 1 � � �S <br /> � '1cu, � �t- �-�-'�-- <br /> Applicant Permitee Signature Date Issued By Signature Date <br />