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CITY OF ORONO PERMIT NO.: 2011-00270 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 05/02/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS 3600 TOGO RD <br /> PIN 17-117-23-31-0048 <br /> LEGAL DESC HALCYON HOLLOW <br /> LOT 002 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 /> CHAMPION PLUMBING LLC <br /> 3670 DODD ROAD-SUITE 100 STATE SURCHARGE PLBG(<$500) 5.00 <br /> EAGAN,MN 55123- MAIL-IN FEE 2.00 <br /> Q TOTAL 22.00 <br /> Minnesota State License#: 6177OPM <br /> OWNER <br /> WELLS,JAMES&KAREN <br /> 3600 TOGO 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 foronly 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 thistype 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 dune cause. <br /> ��� <br /> Appltcant Permitee Signature Date Issue y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />