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CITY OF ORONO * Z 0 1 3 - 0 0 4 3 6 * <br /> 3 2750 KELLEY PARKWAY DATE ISSUED: 06/03/2013 <br /> �. ORONO, MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS � : 225 HOLLANDER RD <br /> PIN : 25-118-23-44-0007 <br /> LEGAL DESC : HOLLY ACRES 2ND ADDN <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER SOFTNER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> CHAMPION PLUMBING LLC STATE SURCHARGE PLBG(<$500) 5.00 <br /> 3670 DODD ROAD- SUITE 100 <br /> EAGAN,MN 55123- MAIL-IN FEE 2.00 <br /> () TOTAL 22.00 <br /> OWNER <br /> CLOSE,JILL&LOUIS <br /> 225 HOLLANDER RD <br /> WAYZATA, MN 55391- <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 goveming 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 aze <br /> requested in conformance with�he State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> �'YV�-�-P �. / / / / <br /> Applicant Permitee Signature Date Issued By nature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E. <br />