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CITY OF ORONO * 2 0 1 6 - 0 1 1 1 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/12/2016 <br /> � ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1385 FOX ST <br /> PIN : 02-117-23-34-0016 <br /> LEGAL DESC : BLUE HILL <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRCICTION TYPE : WATER HEATER <br /> NOTE: REPLACE WATER HEATER <br /> VALUATION OF PLUMB[NG 1100 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 0.55 <br /> WELD&SONS PLUMBING CO INC. MAIL-IN FEE 2.00 <br /> 3410 KILMER LANE N <br /> PLYMOUTH,MN 55441- TOTAL 52.55 <br /> (763)475-0296 Payment(s) <br /> Minnesota State License#: plbg-PC646375,mech-MB003315 CHECK 10459 52.55 <br /> OWNER <br /> BERGENSTAL&MARILYN GEHRMAN,CAROL <br /> 1385 FOX ST <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 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 l80 days at any[ime 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 /> 7 ._ F ��� c <br /> �M�r� � ��.� -��� � � �-ra� � , �z, � � <br /> Applicant Permitee Signature Date Issued By Signature Date <br />