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CITY OF ORONO * 2 0 1 7 - 0 0 1 7 5 * <br /> � � 2750 KELLEY PARKWAY DATE ISSUED: 02/23/2017 <br /> �� ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2701 KELLY AVE <br /> PIN : 21-117-23-23-0040 <br /> LEGAL DESC : WALTERS PORT <br /> : LOT 001 BLOCK 002 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTIOIY TYPE : WATER HEATER <br /> NOTE: REPLACE WATER HEATER <br /> VALUATION OF PLUMBING 600 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 0.30 <br /> APPLIANCE CONNECTIONS, INC. MAIL-IN FEE 2.00 <br /> 12850 CHESTNUT BLVD <br /> SHA.KOPEE, MN 55379- TOTAL 52.30 <br /> (952)445-4803 Payment(s) <br /> Minnesota State License#:mech-MB004165 CHECK 9197 5230 <br /> OWNER <br /> STORLIE, TED& WENDY <br /> 2701 KELLY AVE <br /> EXCELSIOR, MN 55331- <br /> AGREEMENT AND SWORN STATEMEfYT <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 /> S[ate Building Code. This permit is for only the work described and does <br /> not grant permission fi�r 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 I 80 days of the date of issuance,or if construction is <br /> suspended for a period of I RO days at any time after work has commenced. <br /> The applicant is responsible for assuring aIl required inspections are <br /> requcsted in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. r, �C-� <br /> '�� ��7 , <br /> � �� �:'�--r�--C-'� ��`_�-k�`��-' -3--_� �� �-- <br /> Applicant Permitee ignature Date Issued By Signature Date <br />