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CITY OF ORONO PERMIT NO.: 2011-01428 <br /> � 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE IssuED: 1U10/20ll <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2880 FOX ST <br /> PIN : 04-117-23-31-0011 <br /> LEGAL DESC : AUDITOR'S SUBD.NO.230 <br /> : LOT 023 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RES(DENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> CHAMPION PLUMBING LLC STATE SURCHARGE PLBG (<$500) 5.00 <br /> 3670 DODD ROAD-SUITE 100 <br /> EAGAN, MN 55123- MAIL-IN FEE 2.00 <br /> O TOTAL 22.00 <br /> Minnesota State License#: 61770PM <br /> OWNER <br /> THOMPSON, LESTER <br /> 2880 FOX ST <br /> RT 1 BOX 325 T <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> "I�he work for which this permit is issued shall be performed according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> State[3uilding Code. This permit is for only the work described and docs <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances goveming this type of wo�k <br /> shall be compied with whe[her 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 da[e 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 caus�. <br /> �,�1'�'� l�.t' / / / / <br /> Applicant Permitee Signature Date Issued By Sig ure Date <br /> SEPARATE PERI��!ITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO . <br />