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'i ' <br /> CITY OF ORONO * z 0 1 7 - 0 0 7 6 z * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/06/2017 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 255 CRESTVIEW AVE <br /> PIN : OS-117-23-14-0021 <br /> LEGAL DESC : BAYSIDE ADDN TO LAKE MINNETONK <br /> : LOT 004 BLOCK 002 <br /> PERM[T TYPE : PLUMBING <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER HEATER <br /> NOTE: REPLACE WATER HEATER <br /> VALUATION OF PLUMBING 1500 <br /> APPLICANT PLUMBING F[XTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 1.00 <br /> CHAMPION PLUMBING LLC MAIL-IN FEE 2.00 <br /> 3670 DODD ROAD-SUITE 100 <br /> EAGAN, MN 55123- TOTAL 53.00 <br /> �� Payment(s) <br /> Minnesota State License#:plbg-PC000308,mech-MB005365 CHECK 34780 53.00 <br /> OWNER <br /> REIMAN, STEPHANIE <br /> 255 CRESTVIEW AVE <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 E3uilding 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 typc of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become null and void if constraction authorized is not <br /> commenced within 1 AO 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 Yor 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 /> � �j � j���� � l � l � 7 <br /> Applicant Permitee Signature Date �Issued y Signature Date <br />