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� a CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 5 — 0 1 0 7 4 * <br /> DATE ISSUED: 08/24/2015 <br /> ORONO,MN 55356— <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2499 KELLY AVE <br /> PIN : 20-117-23-12-0052 <br /> LEGAL DESC : KELLY COVE <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: WATER HEATER REPLACEMENT <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> STATE SURCHARGE PLBG(<$500) 1.00 <br /> WELD&SONS PLUMBING CO INC. MAIL-IN FEE 2.00 <br /> 3410 KILMER LANE N <br /> PLYMOUTH,MN 55441- TOTAL 18.00 <br /> (763)475-0296 Payment(s) <br /> Minnesota State License#:plbg-PC646375,mech-MB003315 CHECK 10161 18.00 <br /> OWNER <br /> PLEWKA&ROBIN DODSON,MARK <br /> 2499 KELLY AVE <br /> EXCELSIOR,MN 55331- <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 dces <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 construc[ion is <br /> suspended for a period of I80 days at any time after work has commenced. <br /> The applicant is responsible for assuring all required inspections aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> �.(^� 6TS c� � � <br /> Applicant Permitee Signature Date Is ed y Signature Date <br />