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�" � CITY OF ORONO <br /> 2750 KELLEY PARKWAY * � 0 1 3 - 0 0 1 1 3 * <br /> DATE ISSUED: 02/19/2013 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1870 SIXTH AVE N <br /> PIN : 27-118-23-42-0022 <br /> LEGAL DESC : WOLSFELD LAKE COMPANY ADDN <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: WATER HEATER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> APPLIANCE CONNECTIONS STATE SURCHARGE PLBG(<$500) 5.00 <br /> 12850 CHESTNUT BLVD <br /> SHAKOPEE, MN 55379 MAIL-IN FEE 2.00 <br /> (952)445-4803 TOTAL 22.00 <br /> Minnesota State License#:057209PM PAID WITH CC# 5244 <br /> OWNER <br /> HERNANDEZ,PHILLIP&MARY <br /> 1870 SIXTH AVE N <br /> LONG LAKE,MN 55356- <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 wark 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 180 days at any time after work has commenced. <br /> The applicant is responsible for assuring all required inspections aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> ��t��[��� � �� � �3 a i/ i <br /> Applicant erm�ee Signature Date ssue y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />