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CITY OF ORONO PERMIT NO.: 2010-01208 <br /> � 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DA7'E �ssUE�: 12/27/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1690 CONCORDIA ST <br /> PIN : 17-117-23-22-0031 <br /> LEGAL DESC : COFFEES ADDN TO SHADY WOOD LAK <br /> : LOT 029 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 /> NORBLOM PLUMBING CO. STATE SURCHARGE PLBG (<$500) 5.00 <br /> 2905 GARFIELD AVENUE S. <br /> MINNEAPOLIS, MN 55408- MA1L-IN FEE 2.00 <br /> (612) 827-4033 TOTAL 22.00 <br /> OWNER <br /> PALM, RICHARD& KIRSTEN <br /> 1690 CONCORDIA ST <br /> _ _ . . _ <br /> WAYZATA, MN �5391 <br /> AGREEMENT AND SWORN STATEMENT _...._ _.___ <br /> _.. <br /> _ _.__.. _ <br /> fhe���ork for�chich this permit is issued shall be perlormed according to <br /> the approved plans and speci�ications.applicable City approv�ilS,and the <br /> .. _. . .. <br /> State Building Code. 'I'his permit is for only the work described and does ���� " � � � - --� <br /> not�rant pennission for�dditional or related work which requires separate <br /> pennits. All provisions of laws and ordinances goveming this type uf work � � — � <br /> shall be compied�vith���hether or not specified herein.This permit will � <br /> expire and become null and void i�fconstruction auth,prized 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 assuri�ig all required inspections are <br /> requested in conionnance���ith the State l3uilding Code.This pennit may be <br /> revoked at any time for due cause. <br /> , <br /> �_i�� �i/l� / / � <br /> Applicant Permitce Signature Datc Issued By.'i ❑ature <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHE HAN DESCRIBED ABO <br />