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. CITY OF ORONO * z 0 1 4 - 0 0 4 7 6 * <br /> 275Q KELLEY PARKWAY DATE ISSUED: OS/19/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3500 BAYSIDE RD <br /> PIN : OS-117-23-13-0015 <br /> LEGAL DESC : AUDITOR'S SUBD. NO. 203 <br /> : LOT 024 BLOCK 000 <br /> PERMIT TYPE : PLUMBING (<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NO"[�E: W�"fI;R SOFTF,NF,R <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> STATE SURCHARGE PLBG(<$500) 5.00 <br /> CULLIGAN SOFT WATER SERVICE CO. MAIL-IN FEE 2.00 <br /> 6030 CULLIGAN WAY <br /> MINNETONKA, MN 55345 TOTAL 22.00 <br /> (952)912-7379 Payment(s) <br /> CREDIT CARD 8645 22.00 <br /> OWNER <br /> BANGERT, MR. & MRS. <br /> 3500 BAYSIDE RD <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work Cor 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 /> not grant permission tbr 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 hercin.'I'his 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 aiter work has commenced. <br /> (he applicant is responsible for assuring all required inspec[ions are <br /> requested in contbrmance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> �3���fl�-i�� ��� � � /9 � /'S� <br /> Applicant Permitee Sign re Date Issued y Signature Uate � <br />