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- � CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 2 - 0 0 2 z 8 * <br /> DATE ISSUED: 03/27/2012 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 75 CRYSTAL CREEK RD <br /> PIN . 33-118-23-33-0003 <br /> LEGAL DESC : CRYSTAL CREEK <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: WATGR SOPTGNGR <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> CULL[GAN SOFT WATER SERVICE CO. STATE SURCHARGE PLBG (<$500) 5.00 <br /> 6030 CULLIGAN WAY <br /> MINNETONKA, MN 55345 MA[L-IN FEE 2.00 <br /> (952)912-7379 TOTAL 22.00 <br /> PA[D WITH CC# 0597 <br /> OWNER <br /> LARSON, ERIC& PAMELA <br /> 75 CRYSTAL CREEK RD <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> Thc 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 scparate <br /> permits. All provisions of laws and ordinances govcrning this type of«ork <br /> shall be compied with whether or not speciticd herein.'l his permit will <br /> expire and become null and void if consVuction 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 t��r 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 /> rv�_�,�� � , �� , �� � ,a�z, � <br /> Applicant Permitee Signature Date Issu E3y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />