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CITY OF ORONO *2 0 1 4 — 0 1 1 9 3 * <br /> • —� 2750 KELLEY PARKWAY DATE ISSUED: 10/15/2014 <br /> � ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952 249-4616 <br /> ADDRESS : 3726 LIVINGSTON AVE <br /> PIN : 17-117-23-34-0053 <br /> LEGAL DESC : LAKE MINNETONKA WOODS � <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> NOTE: 1 WATER HEATER <br /> cre,� <br /> ��� <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> ECOWATER STATE SURCHARGE PLBG(<$500) 5.00 <br /> 3208 FIRST STREET S MAIL-IN FEE 2.00 <br /> WAITE PARK,MN 56387- TOTAL 22.00 <br /> (320)251-2505 Payment(s) <br /> CREDIT CARD 3331 22.00 <br /> OWNER <br /> MATSEN,MARK <br /> 3726 LIVINGSTON AVE <br /> WAYZATA,MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this pertnit 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 dces <br /> not grant permission for additional or related work which requires separate <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 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 with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> V ' \� �-� �\�1J�_ ��LAc� �� /,'� / /� <br /> Applicant Permitee Signature Date Issued y Signature Date <br />