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CITY OF ORONO * Z 0 1 5 — 0 1 4 6 0 * <br /> � 2750 KELLEY PARKWAY DATE [SSUED: 1U12/2015 <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 /> PERM[T TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCT[ON TYPE : WATER HEATER <br /> NOTE: REPLACE WATER I-iEATER <br /> APPLICANT PLUMB[NG FIXTURE FEE(<$500) 15.00 <br /> STATE SURCHARGE PLBG(<$500) 1.00 <br /> APPLIANCE CONNECTIONS, INC. MAIL-IN FEE 2.00 <br /> 12850 CHESTNUT BLVD <br /> SHAKOPEE,MN 55379- TOTAL 18.00 <br /> (952)445-4803 Payment(s) <br /> Minnesota State License#:mech-MB004165 CHECK 7822 18.00 <br /> OWNER <br /> PONZETTI, ROBERT& BARBARA <br /> 2545 KELLY AVE <br /> EXCELSIOR, MN 55331 <br /> AGREEMENT AND SWORIv 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 Iaws 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 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 /> �-^� � _ � ;1 <br /> � <br /> il� �i��(,.�i. ���� �,L�l 1 ` ��.���� � ����=`L_; — �' <br /> � �� l r � ► --� d <br /> Applicant Permitee Signature � Date Issued By Signature Date <br />