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CITYOFORONO * Z0 13 - PJ0939 * <br /> ' 2750 KELLEY PARKWAY DATE ISSUED: 09/l2/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2995 DEER RUN TR <br /> PIN : 04-117-23-23-0030 <br /> LEGAL DF.SC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING (<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER SOFTNER <br /> APPLICANT PLUMBING FIXTURE FEE (<$500) I5.00 <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 /> HICKS, STEVEN & TAMARA <br /> 2995 DEER RUN TR <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORN STATEMENT <br /> �Che work t�or�vhich this pennit is issued shall be perlormed according to <br /> the approved plans and specifications.applicable City approvals,and the <br /> State Building Code. "I�his permit is for onl}�the�vork described and docs <br /> not grant permission for additional or related work�vhich requires separate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whedier or not specitied herein.This permit will <br /> expire and become null and void if construction�uthorized is not <br /> commenced within 180 days of the date o1�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 tbr assuring all required inspections are <br /> requested in conformance with thc State Building Code �I�his pemiit may bc <br /> revoked at any time t�or due cause. <br /> /✓VG'�K� � � / / <br /> Applicant Permitee Signature Date ]ssued By Sig ure Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />