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,. CITY OF ORONO * z 0 1 5 - 0 0 5 1 6 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 04/30/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2545 KELLY AVE <br /> PIN : 20-117-23-11-0023 <br /> LEGAL DESC : TOWNSITE OF LANGDON PARK <br /> : LOT 002 BLOCK 005 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER SOFTNER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> STATE SURCHARGE PLBG(<$500) 5.00 <br /> ECOWATER MAIL-IN FEE 2.00 <br /> 3208 FIRST STREET S <br /> WAITE PARK,MN 56387- TOTAL 22.00 <br /> (320)251-2505 Payment(s) <br /> Minnesota State License#:plbg-PC643402 CREDIT CARD 3331 22.00 <br /> OWNER <br /> PONZETTI, ROBERT&BARBARA <br /> 2545 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 permi[may be <br /> revoked at any time for due cause. <br /> '�1/ �� l'7'�'— �Y'��L.I'7 � �� 3O� l <br /> Applicant Permitee Signature Date Issued By Signature Date <br />