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CITY OF ORONO * Z 0 1 4 - 0 P1 9 6 4 * <br /> ^ 2750 KELLEY PARKWAY DATE ISSUED: 08/26/2014 <br /> � ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952)249-4616 <br /> ADDRESS : 2509 KELLY AVE <br /> PIN : 20-117-23-12-0037 <br /> LEGAL DESC : REG.LAND SURVEY NO. 1428 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES-MULTIPLE <br /> NOTE: 1ST FLOOR: 1 KITCHEN SINK, 1 DISPOSAL, 1 DISHWASHER, I LAUNDRY TRAY, 1 WASHER <br /> VALUATION OF PLUMBING 2400 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> RIVERSIDE MECHANICAL STATE SURCHARGE PLBG(VALUATION) 1.20 <br /> 12460 ZINRAN AVENUE MAIL-IN FEE 2.00 <br /> SAVAGE,MN 55378- TOTAL 53Z0 <br /> Minnesota State License#:plbg-PC644809,mech-MB650157 Payment(s) <br /> CHECK 3964 53.20 <br /> OWNER <br /> NADLER,CHARLES&CANDICE <br /> 2509 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 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 are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> — " �- ___.__ / / <br /> Applicant Permitee Signature Date Issued By S ature Date <br />