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CITYOFOR NO * 2017 — rd0558 * <br /> 2750 KELLEY P WAY DATE ISSUED: 05/23/2017 <br /> � ORONO,MN 5 356- <br /> (952) 249-4600 FAX: (�52)249-4616 <br /> ADDRESS : 1750 SHADYWOOD RD <br /> PIN : 17-117-23-21-0021 <br /> LEGAL DESC : SHADY-WOOD <br /> : LOT 016 BLOCK 000 <br /> PERMIT TYPE : WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION � <br /> NOTE: GOES WITH 2O17-00234,CONTRACTOR MISSED FILLING OUT WH N THEY APPLIED FOR SEWER DISCONNECT. <br /> WATER DISCONNECT ONLY <br /> � <br /> I <br /> i <br /> APPLICANT WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> STONEWOOD,LLC TOTAL 51.00 <br /> 153 E LAKE STREET PaymenR(s) <br /> WAYZATA,MN 55391- CHECK 14781 51.00 <br /> (612)462-4000 <br /> Minnesota State License#:BUIL-BC594315 <br /> OWNER <br /> SHAW,GRETCHEN&LYLE <br /> 7001 KENESTON DR <br /> EDEN PRAIRIE,MN 55346- <br /> AGREEMENT AIVD SWORN STATEMENT <br /> The work for which this permit is issued shall be performed acwrding 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 dces <br /> not grant permission for additional or rel8ted work which requires separate <br /> permits. All provisions of laws and ordinances goveming this rype 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 conformanc ith the State Building Code.This permit may be ,n <br /> revoked at any tim r due caus <br /> -a. � �/� <br /> _� <br /> �. - j � � ��.--���� S� �3 / <br /> ppli ignature Dat Issued y Signature Date <br />