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' � CITY OF ORONO <br /> * Z 0 1 4 - 0 PJ 0 6 PJ * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OU2U2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 220 CYGNET PL <br /> PIN : 04-117-23-23-0014 <br /> LEGAL DESC : SWAN LAKE ADDN <br /> : LOT 005 BLOCK 003 <br /> PERMIT TYPE : PLUMBING (<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOT�: WATER SOF"1'GNER <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 /> CREDTT CARD 8645 22.00 <br /> OWNER <br /> HAYES, CHRISTOPHER&ANDRE <br /> 220 CYGNET PL <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which[his 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 pennission tbr additional or rela[ed 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 herein.This permit wil) <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 days of the da[e of issuance,or if construction is <br /> suspended for a period of 180 days at any time afrer work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with the State E3uilding Code.This permit may be <br /> revoked at any time for due cause. <br /> / Z/ / / iZ� i /� <br /> Applicant Permitee Signature ate Issue y Signature Date <br />