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CITY OF ORONO �� � � �� '11 <br /> * 20 1 7 - 0 1 1 09 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/22/2017 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2625 KELLY AVE <br /> PIN : 20-117-23-14-0026 <br /> LEGAL DESC : TOWNSITE OF LANGDON PARK <br /> : LOT 000 BLOCK 005 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: WATER AND SEWER DISCONNECTION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> J S STEWART COMPANIES,INC. STATE SURCHARGE SEWER&WATER 1.00 <br /> 11030 LAMONT AVE NE <br /> HANOVER,MN 55341 MAIL-IN FEE 2.00 <br /> () TOTAL 103.00 <br /> Minnesota State License#:sept-L703 Payment(s) <br /> CHECK 7934 103.00 <br /> OWNER <br /> ELLEN REDMOND REVOC TRUST <br /> 2625 KELLY AVE <br /> EXCELSIOR,MN 55331- <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 /> gay /7 <br /> Applicant Permitee Signature Date Issued B ignature Date <br />