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VA CITY OF ORONO RKRUNNIMM <br /> 2750 KELLEY PARKWAY * 2 0 1 7 - 0 1 2 0 <br /> DATE ISSUED: 09/28/2017 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS 155 TRUFFULA TR <br /> PIN 33-118-23-44-0040 <br /> LEGAL DESC MEADOW WOOD POND <br /> LOT 006 BLOCK 001 <br /> PERMIT TYPE PLUMBING <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE WATER HEATER <br /> NOTE: WATER HEATER REPLACEMENT <br /> VALUATION OF PLUMBING 1045 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> A.C.TOMPKINS PLBG&HEATING <br /> STATE SURCHARGE PLBG(VALUATION) 0.52 <br /> MAIL-IN FEE 2.00 <br /> 16445 221ST AVE NW <br /> ELK RIVER,MN 55330- TOTAL 52.52 <br /> (952)420-9028 Payment(s) <br /> Minnesota State License#:mech-PC650084 CHECK 5432 52.52 <br /> OWNER <br /> STAGGS,JEFF <br /> 155 TRUFFULA TR <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 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 /> r <br /> Applicant Permitee Signature Date Issued By Sighature Date <br />