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� r .n <br /> CITY OF ORONO � 0 1 6 — 0 1 1 3 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/19/2016 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2725 PHEASANT RD <br /> PIN : 21-117-23-23-0024 <br /> LEGAL DESC : PHEASANT LAWN <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: WATER HEATER <br /> VALUATION OF PLUMBING 1000 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 1.00 <br /> CHAMPION PLUMBING LLC MAIL-IN FEE 2.00 <br /> 3670 DODD ROAD-SUITE 100 TOTAL 53.00 <br /> EAGAN,MN 55123- Payment(s) <br /> Minnesota State License#:plbg-PC000308,mech-MB005365 CHECK 33374 53.00 <br /> OWNER <br /> SEIFERT,THOMAS&DARYL <br /> 2725 PHEASANT RD <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 perrr►it 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 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 I80 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> ,� // / /v <br /> Applican Permitee Signature Date Issued B gnature Date <br />