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� ,; CITY OF ORONO * z 0 1 z - 0 1 1 2 5 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 11/03/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3630 EILEEN ST <br /> PIN : OS-117-23-21-0013 <br /> LEGAL DESC : RIEDEL CO STUBBS BAY ADDN <br /> : LOT 003 BLOCK 001 <br /> PERMIT TYPE : PLUMBING (<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTIOIY 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 /> MINNEAPOL[S, MN 55408- MAIL-IN FEE 2.00 <br /> (612)827-4033 MISC FEE 0.00 <br /> TOTAL 22.00 <br /> OWNER <br /> [LSE, DAVID& SHEROKEE <br /> 3630 EILEEN ST <br /> MAPLE PLAIN, MN 55359- <br /> AGREEMENT AND SWORN STATEMENT <br /> I'hc work for which this pcm�it is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State[3uilding Code. This permit is for only the work described and does <br /> not grant permission for additional or related work which requires separatc <br /> permits. All provisions ot�laws and ordinances goveming this type of�vork <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become null and void it�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[ime atter work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with the State F3uilding Code.This permit may be <br /> revoked at any time for due cause. <br /> `�12Q-1.� L� / / ���'►�C--�-Yc� / / <br /> Applicant Permitee Signature Date [ssued By � nature a e <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E. <br />