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CITY OF ORONO * Z 0 1 5 - 0 1 4 5 9 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 1U12/2015 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1082 LOMA LINDA AVE <br /> P[N : 08-117-23-23-0009 <br /> LEGAL DESC : LOMA LINDA <br /> : LOT 008 BLOCK 000 <br /> PERMIT TYPE : PLUMB[NG(<$500) <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> NOTE: REPLACE WATER HEATER <br /> APPL[CANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> STATE SURCHARGE PLBG(<$500) 1.00 <br /> APPLIANCE CONNECTIONS, INC. MAIL-IN FEE 2.00 <br /> 12850 CHESTNUT BLVD <br /> SHAKOPEE,MN 55379- TOTAL 18.00 <br /> (952)445-4803 Payment(s) <br /> Minnesota State License#:mech-MB004165 CHECK 7677 18.00 <br /> OWNER <br /> TOMAN,JULIE <br /> 1082 LOMA LINDA AVE <br /> MOUND,MN 55364 <br /> AGREEMENT AND SWORN STATEMEI�TT <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 addi[ional 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 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. 1 / �,C_1 <br /> ; � � /% /��,'��� /,l ;, � �_ <br /> l� �1�_� (� (`�i.�.� � �� C,� � C=� � � <br /> Applicant Permitee Signature Date Issued By Signa�dre Date <br />