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c • <br /> CITY OF ORONO * 2 0 1 7 - 0 1 3 8 0 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/23/2017 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3865 NORTH SHORE DR <br /> PIN : 17-117-23-22-0002 <br /> LEGAL DESC : UNPLATTED 17 117 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> NOTE: REPLACE WATER HEATER <br /> VALUATION OF PLUMBING 1000 <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 CHEST'NUT BLVD <br /> SHAKOPEE,MN 55379- TOTAL 52.30 <br /> (952)445-4803 Payment(s) <br /> Minnesota State License#: mech-MB004165 CHECK 9763 52.30 <br /> OWNER <br /> DOBRATZ,MR.&MRS. MARK <br /> 3865 NORTH SHORE DR <br /> MO[JND, MN 55364- <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 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 /> `� ; ,� <br /> (�—vL�Lu.c.=C�:,� � /C�G '�� �U � �� �� <br /> Applicant Permitee Signature Date Issued B Signature Date <br />