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1 ' CITY OF ORONO * z 0 1 3 - 0 0 8 1 8 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 08/19/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2700 SIXTH AVE N <br /> PIN : 28-118-23-42-0002 <br /> LEGAL DESC : FAZENDIN FOREST <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: WA"I"ER SOF�I�,NER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> CULLIGAN SOFT WATER SERVICE CO. STATE SURCHARGE PLBG(<$500) 5.00 <br /> 6030 CULLIGAN WAY <br /> MINNETONKA, MN 55345 MAIL-IN FEE 2.00 <br /> (952)912-7379 TOTAL 22.00 <br /> PAID WITH CC# 0597 <br /> OWNER <br /> STF,PHENSON HOLDINGS <br /> LONG LAKE, MN 55356-0177 <br /> AGREEMENT AND SWORN STATEMENT <br /> Che work for which this permit is issued shall be perfonned 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 /> no[grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinanccs governing this type o1'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 /> ��c-�-�-��� �� ��/ �_/� �% l �� /3 <br /> Applicant Permitee Signature Date Iss By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER TI-IAN DESCRIBED ABOVE. <br />