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_ , CITY OF ORONO * 2 0 1 4 - 0 0 4 1 3 * <br /> 2750 K�LLEY PARKWAY pATE �SSUE�: 05/07/2014 <br /> ' ORONO, MN 55356- <br /> � (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3048 NORTH SHORE DR <br /> PIN : 09-117-23-32-0004 <br /> LEGAL DESC : CRYSTAL BAY PARK <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: WATER SOFTENER <br /> VALUATION OF PLUMBING 490 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG (VALUATION) 025 <br /> RICHARD'S CUS�f'OM WATER <br /> 6121 EXCELSIOR BLVD. #206 TOTAL 50.25 <br /> ST. LOUIS PARK, MN 55416- Payment(s) <br /> CHECK 13078 50.25 <br /> (952)920-1200 <br /> Minnesota State License#: BUIL-WM061456 <br /> OWNER <br /> KALLAS, KATHRYN D <br /> ll653 CEDAR PASS <br /> HOPKINS, MN 55343- <br /> AGREEMENT AND SWORN STATEMENT <br /> The 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 Buildinp Code. This permit is for only the work described and does <br /> not grant pennission for additional or related work which requ�res separate <br /> permits. All provisions of laws and ordinances governing this rype of work <br /> shall be compied with whether or not specitied herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced wid�in 180 davs of the date of issuance,or if construction is <br /> suspended for a period of l80 days at any time afrer work has commenced. <br /> The applicant is resp�sible for assuring all required inspections are <br /> requested in confo ance with the State Building Code.This permit may be <br /> revoked at any lim�for due cause. <br /> � ��;�� <br /> ,� <br /> �,_`"i' "j`/ /�/' cJ � 7 /� <br /> pli ant er ' e � nature Date I ed By Signature Date <br />