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CITY OF ORONO PERMIT NO.: 2011-01578 <br /> �, 2750 KELLEY PARKWAY <br /> ' ORONO, MN 55356- DATE ISSUED: 12/2U2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3300 FOX ST <br /> PIN : OS-117-23-44-0003 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1358 <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) 15.00 <br /> WATER DOCTORS STATE SURCHARGE PLBG(<$500) 5.00 <br /> 8201 CENTRAL AVENUE <br /> SPRING LAKE PARK, MN 55432- TOTAL 20.00 <br /> (763)286-6243 <br /> Minnesota State License#: 082337 <br /> OWNER <br /> TRUBECK, WILLIAM &JUDITH <br /> 3300 FOX ST <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 specitications,applicable City approvals,and the <br /> State E3uilding Code. This permit is for only the work described and does <br /> no[grant pernussion for additional or related work which rcquires separa[e <br /> perm�ts. All provisions of laws and ordinances governing this type of work <br /> shall be compied with�vhether or not specified herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced wi[hin I80 days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time atter 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 /> �� � i i i i <br /> Applicant Permitee Signature Date Issued By Si ature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED AB E. <br />