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r <br /> . <br /> CITY OF ORONO * z 0 1 z — 0 0 2 2 9 * <br /> 2750 KELLEY PARKWAY pATE �SSUEn: 03/27/2012 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 140 CRYSTAL CREEK RD <br /> PIN : 33-118-23-33-0010 <br /> LEGAL DESC : CRYSTAL CREEK <br /> : LOT 004 BLOCK 002 <br /> PERMIT TYPE : PLUMBING (<$500) <br /> PROPERTY TYPE : RES[DENT[AL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NO"I'E: 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 /> �9s2�912-r�9 TOTaL 22.00 <br /> PAID WITH CC# 0597 <br /> OWNER <br /> BRODEN, DAVID& LAYLON <br /> 140 CRYSTAL CREEK RD <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORN STATEMENT <br /> "I'hc 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 this type of work <br /> shali 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 I 80 days at any time after�i�ork 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[im�for due cau . <br /> �3 � d7� « � ��7� / <br /> Applicant Permitee Signature Date Issu E3y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />