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, CITY OF ORONO * Z 0 1 5 - 0 0 5 3 4 * <br /> ,, 2750 KELLEY PARKWAY DATE ISSUED: OS/04/2015 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 335 HOLLANDER RD <br /> PIN : 25-118-23-43-0009 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1429 <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 /> APPLIANCE CONNECTIONS, INC. MAIL-IN FEE 2.00 <br /> 12850 CHESTNUT BLVD <br /> SHAKOPEE,MN 55379- TOTAL 22.00 <br /> (952)445-4803 Payment(s) <br /> Minnesota State License#: mech-MB004165 CHECK 6459 22.00 <br /> OWNER <br /> ERICKSON,WALTER&NANCY <br /> 335 HOLLANDER 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 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 whether or not specified herein.This permit will <br /> expire and become null and void if cons[ruction 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 after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance wi[h the State Building Code.This permit may be <br /> revoked at any time for due cause. /r,!n <br /> /Uy <br /> ' , � � ���t ( ���'Y�C..���`� � � ��/ � � �, <br /> Applicant Permitee S' nat re Date Issued By Signature Date <br />