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CITY OF ORONO rERMiT No.: 2011-00956 <br /> 2750 KELLEY PARKWAY <br /> ` ORONO,MN 55356- DATE IssuEn: 08/29/2011 <br /> { 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 585 STUBBS BAY RD N <br /> PIN : 32-118-23-24-0006 <br /> LEGAL DESC : UNPLATTED 32 118 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> NOTE: WATER HEATER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> APPLIANCE CONNECTIONS STATE SURCHARGE PLBG(<$500) 5.00 <br /> 1313 DANITA CR. <br /> SHAKOPEE,MN 55379 M.AIL-IN FEE 2.00 <br /> (952)445-4803 TOTAL 22.00 <br /> Minnesota State License#: 057209PM <br /> OWNER <br /> FORT,JOHN&KRISTIN <br /> 585 STUBBS BAY RD 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 dces <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 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 /> / / <br /> Applicant Permitee Signature Date Issued By Si ture ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A . <br />