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t � CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 6 - 0 0 8 9 6 * <br /> DATE ISSUED: 07/28/2016 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 500 OXFORD RD <br /> PIN : OS-117-23-41-0015 <br /> LEGAL DESC : STIELOWS ADDN <br /> : LOT 007 BLOCK 001 <br /> PERMIT TYPE : PLUMBING <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: WATER HEATER <br /> VALUATION OF PLUMBING 900 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 0.45 <br /> AIRICS HEATING LLC MAIL-IN FEE 2.00 <br /> 2609 HWY 13 W <br /> BURNSVILLE,MN 55337- TOTAL 52.45 <br /> (952)345-0032 Payment(s) <br /> Minnesota State License#:mech-MB004088 CHECK 16299 52.45 <br /> OWNER <br /> NELSON,ALBIN&SUSAN <br /> 500 OXFORD 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 dces <br /> not gant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances goveming this rype of work <br /> shall be compied with whether or not specified herein.This permit will <br /> exp've and become null and void if construction authorized is not <br /> commenced within I80 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 /> C,►���� ? /��/ �� <br /> Applicant Permitee Signature Date Iss ed y Signature Date <br />