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CITY OF ORONO PERMIT NO.: 2009-00�00 <br /> � 2750 KELLEY PARKWAY <br /> * ORONO,MN 55356- DATE IssuEn: 03/09/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1465 LONG LAKE BLVD <br /> PIN : 35-118-23-22-0005 <br /> LEGAL DESC : REG.LAND SURVEY NO. 1379 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> APPLICANT WATER HEATER 15.00 <br /> CHAMPION PLUMBING LLC STATE SURCHARGE PLBG(<$500) 0.50 <br /> 3670 DODD ROAD-SUITE 100 <br /> EAGAN,MN 55123- MAIL-IN FEE 2.00 <br /> () MISC FEE 0.00 <br /> Minnesota State License#: 61770PM TOTAL 17.50 <br /> OWNER <br /> LUND,DONALD <br /> 1465 LONG LAKE BLVD <br /> LONG LAKE,MN 55356 <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 the State Building Code.This permit may be <br /> revoked at any time for dqe cause. <br /> ' "�,f �il� � � / / <br /> Applicant Permitee Signature Date Issued B gnature ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED B VE. <br />