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7 CITY OF ORONO <br /> 2 * Z P1 1 7 — e PJ 2 1 6 <br /> 750 KELLEY PARKWAY <br /> DATE ISSUED: 03/08/2017 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952)249-4616 <br /> ADDRESS 4515 NORTH SHORE DR <br /> PIN 07-117-23-31-0006 <br /> LEGAL DESC BERGQUISTS ADDN TO SAGA HILL <br /> LOT 008 BLOCK 000 <br /> PERMIT TYPE PLUMBING <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE WATER HEATER <br /> NOTE: WATER HEATER REPLACEMENT <br /> VALUATION OF PLUMBING 500 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 0.25 <br /> NORBLOM PLUMBING CO. <br /> 1465 SELBY AVE MAIL-IN FEE 2.00 <br /> ST.PAUL,MN 55104- TOTAL 52.25 <br /> (612)827-4033 Payment(s) <br /> CHECK 11389 52.25 <br /> OWNER <br /> R N MCLELLAN REVOC TRUST <br /> 4515 NORTH SHORE DR <br /> MOUND,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 t80 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 /> Applicant Permitee Signature Date IssueQB Signature Date <br />