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� � CITY OF ORONO * z 0 1 7 — 0 0 6 ra 8 * <br /> ' 2750 KELLEY PARKWAY DATE ISSUED: 06/OS/2017 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3340 SHORELINE DR <br /> PIIV : 17-117-23-44-0085 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1433 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : WATER <br /> PROPERTY TYPE : COMMERCIAL-BUSINESS <br /> CONSTRUCTION TYPE : REPAIR <br /> NO'I'E: WATER REPAIR-PIPE S[ZE 2"-COPPER <br /> APPLICANT WATERCONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> INTERSTATE REMOVAL LLC MAIL-IN FEE 2.00 <br /> 20920 FOREST RD N <br /> P O BOX 1028 TOTAL 53.00 <br /> FOREST LAKE,MN 55025- Payment(s) <br /> (651)248-7445 CHECK 222523 53.00 <br /> Minnesota State License#: SW-PM064972 <br /> OWNER <br /> Holiday Companies <br /> GLEASON,NICK <br /> PO BOX 1224 <br /> MINNEAPOLIS, MN 55440- � <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 Ciry 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 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 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 /> ( <br /> � -ellb'U (�i' lJr' il� <br /> Appiicant Permitee Signature Date Issu d B Signature Date <br />