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' ' CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 2 - 0 0 7 4 6 * <br /> DATE ISSUED: 08/OU2012 <br /> ORONO,MN 55356- <br /> 952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 3100 RIDGEWOOD CIR <br /> PIN : 04-117-23-23-0023 <br /> LEGAL DESC : ROUTSON ADDN <br /> : LOT 003 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> COPISTRUCTION TYPE : FIXTURE <br /> NOTE: WATER SOFTENER <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 /> BURNS,GARY&STACY <br /> 3100 RIDGEWOOD CIR <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 sepazate <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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> / / �� /7 /� / "�_ <br /> ci [ <br /> Applicant Permitee Signature Date Issued Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />