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• . CITY OF ORONO PERMIT NO.: 2010-00961 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUEu: 10/07/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3965 BAYSIDE RD <br /> PIN : OS-117-23-23-0004 <br /> LEGAL DESC : AUDITOR'S SUBD.NO. 203 <br /> : LOT 057 BLOCK 000 <br /> PERMIT TYPE : PLUMBING (<$500) <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCTION TYPE : WATER SOFTNER <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 /> FELDMANN,GUY <br /> 3965 BAYSIDE RD <br /> LONG LAKE,MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this pennit is issued shall be performed according to <br /> Ihe 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 separate <br /> permits. All provisions of laws and ordinances governing ihis type of work <br /> shall be compied with whe[her or not specified herein.'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 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 c use. <br /> ��,��.a:c.���� /D/ 7 / l0 �l 7 //D <br /> Applicant Permitee Signature Date Issu By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />