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s ^ <br /> CITY OF ORONO * 2 0 1 3 - 0 0 9 9 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/26/2013 <br /> ORONO, MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2106 SHADYWOOD RD <br /> PIN ; 17-117-23-42-0017 <br /> LEGAL DESC : WILEYS PARK LAKE MTKA <br /> : LOT 000 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: REPLACE WATER HEATER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> APPLIANCE CONNECTIONS STATE SURCHARGE PLBG(<$500) 5.00 <br /> 12850 CHESTNUT BLVD <br /> SHAKOPEE,MN 55379 MAIL-IN FEE 2.00 <br /> (952)445-4803 TOTAL 22.00 <br /> Minnesota State License#: 057209PM <br /> OWNER <br /> JR., WILLIAM SIME <br /> 653 SHADYWOOD RD <br /> ,FL 34145- - - -- _ <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 /> . 4i '�y, �-3 9 .21�✓ ,(j <br /> Applicant ermitee S' ure Date Issu By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />