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1 <br /> 1 <br /> 1 <br /> 1 <br /> CITY OF ORONO � � II S I �1 <br /> .. 2750 KELLEY PARKWAY * 2 0 1 2 — >a 1 1 9 3 <br /> DATE ISSUED: 11/21/2012 <br /> ORONO, MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 480 ORCHARD PARK RD <br /> PIN : 32-118-23-23-0010 <br /> LEGAL DESC : ORCHARD PARK <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: REPLACE WATER HEATER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> API STATE SURCHARGE PLBG(<$500) 5.00 <br /> 307 JACKSON AVE#4 <br /> ELK RIVER,MN 55330- TOTAL 20.00 <br /> (612)290-8959 PAID WITH CC# XXXX <br /> OWNER <br /> BYE,MATTHEW <br /> 480 ORCHARD PARK RD <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 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 /> revoke at any t' e f r e cause. <br /> t 6;4.-CUt— / / / 2-1 / fe___ <br /> Applicant) Trace Si ature Date Issu By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />