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„ CITY OF ORONO PERMIT NO.: 2009-00013 <br /> , 2750 KELLEY PARKWAY <br /> ' ORONO, MN 55356- �ATE ISSUE�: OU13/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1115 COX FARM RD <br /> PIN : 27-118-23-32-0016 <br /> LEGAL DESC : SHADOWOOD FARM <br /> : LOT 004 BLOCK 001 <br /> PERMiT TYPE : PLUMBING (<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> NOTE: WA"CER HGATER <br /> APPLICANT WATER HEATER 15.00 <br /> NORBLOM PLUMB[NG CO. STATE SURCHARGE PLBG (<$500) 0.50 <br /> 2905 GARFIELD AVENUE S. <br /> MINNEAPOLIS, MN 55408- MAIL-IN FEE 1.50 <br /> (612)827-4033 TOTAL 17.00 <br /> OWNER <br /> KOSTIAL, BRADFORD& SARAH <br /> 1 115 COX FARM RD <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORN STATEMENT <br /> The�vork for which this permit is issued shall be performed accordina to <br /> the approved plans and specifications,applicable Ciry approvals,and the <br /> State k3uilding 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 cons[ruction 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 /> "l�he 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 /> ��'11.,�.c-! l�. / / <br /> i i <br /> Applicant Pennitec Signature Date Issued By Si n ture Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESC D ABOVE. <br />