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CITY OF ORONO PERMIT NO.: 2011-01550 <br /> � ' 2750 KELLEY PARKWAY - <br /> ORONO,MN 55356- DATE ISSUED: 1?✓14/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1670 SHADYWOOD RD <br /> PIN : 17-117-23-21-0015 <br /> LEGAL DESC : SHADY-WOOD <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> CHAMPION PLUMBING LLC STATE SURCHARGE PLBG(<$500) 5.00 <br /> 3670 DODD ROAD-SUITE 100 <br /> EAGAN,MN 55123- MAIL-IN FEE 2.00 <br /> O TOTAL 22.00 <br /> Minnesota State License#: 61770PM <br /> OWNER <br /> KIELLEY,DONALD&ARLENE <br /> 1670 SHADYWOOD RD <br /> WAYZATA,MN 55391- <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 dces <br /> not grant permission for additional or related work which requires sepazate <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 aze <br /> requested in conformance with the State Buildi�g Code.This permit may be <br /> revoked at any time for due cause �.,� / <br /> / / L�/� ,,� � <br /> Applicant Permitee Signature Date � / <br /> Issued By Signat Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />