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' CITY OF ORONO <br /> * 2 0 1 3 — 0 0 S 1 7 * <br /> 2750 KELLEY PARKWAY paTE [Ss��n: 08/19/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2184 SHADYWOOD RD <br /> PIN : 17-117-23-42-0008 <br /> LEGAL DESC : WILEYS PARK LAKE MTKA <br /> : LOT Ol6 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NO"I'E: WA"TER SOF"TENER <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 /> PA1D WITH CC# 0597 <br /> OWNER <br /> JOHNSEN& JULIE ANDREWS,ANDREWS <br /> 2184 SHADYWOOD RD <br /> WAYZATA, MN 55391- <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[3uilding Code. "Chis permit is for only the work described and does <br /> not grant permission for additional or related work wl�ich requires separate <br /> permits. All provisions of laws and ordinances goveming this type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become mill and void ifconstruction 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 /> � � �� / � ./� � /�i ,�' <br /> Ap ip canC Permitee Signa Date Issue y Signature � Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />