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, �, CITY OF ORONO * 2 0 1 6 - 0 0 0 4 9 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: OU14/2016 <br /> ORONO, MN 55356- <br /> 952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4470 FOREST LAKE LANDING <br /> PIN : 07-117-23-24-0040 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1472 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING , <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> NOTE: REPLACING A WATER HEATER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 50.00 <br /> CHAMPION PLUMB[NG LLC STATE SURCHARGE PLBG(<$500) 1.00 <br /> 3670 DODD ROAD- SUITE 100 MAIL-[N FEE 2.00 <br /> EAGAN, MN 55123- TOTAL 53.00 <br /> �� Payment(s) <br /> Minnesota State License#:plbg-PC000308,mech-MB005365 CHECK 32253 53.00 <br /> OWNER <br /> PRAWER, STEVEN& SCOTT <br /> 4470 FOREST LAKE LANDING <br /> MOUND, MN 55364- <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 sepazate <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 /> ' �, � �i l <br /> ; l ���,�,A ��,�_ � ��.��v3 , � �,�_���. , „ �.� , , - <br /> Applicant Permitee Signature Date Issued By Sigf�ature Date <br />