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CITY OF ORONO * z � 1 5 - 0 1 1 2 8 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/03/2015 <br /> ' ORONO, MN 55356- <br /> r (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2780 COUNTRYSIDE DR W <br /> P[N : 04-117-23-12-0010 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 002 BLOCK 002 <br /> PERMIT TYPE : PLUMBING (<$500) <br /> PROPERTY TYPE : RES[DENT[AL <br /> CONSTRUCTION TYPE : WATER SOFTNER <br /> NOTE: NGW WATER SOFTNER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> STATE SURCHARGE PLBG(<$500) 1.00 <br /> CULLIGAN SOFT WATER SERVICE CO. MAIL-IN FEE 2.00 <br /> 6030 CULL[GAN WAY <br /> M[NNETONKA, MN 55345- TOTAL 18.00 <br /> (952)912-7379 Payment(s) <br /> CREDIT CARD 8645 18.00 <br /> OWNER <br /> PETERSON,TIM <br /> 2780 COUNTRYSIDE DR W <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 separate <br /> permits. All provisions of laws and ordinances governing[his 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 l80 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 /> `(� <br /> ��c�� �� ��,�:� �c� ZJ1 ���C��� �� , 3 /` <br /> Applicant Permitee Signature Date Issued By Signatu e Date <br />