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, � CITY OF ORONO * Z 0 1 5 - 0 0 9 7 6 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: O8/03/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3115 NORTH SHORE DR <br /> PIN : 09-117-23-32-0013 <br /> LEGAL DESC : REG. LAND SURVEY NO.0269 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTIOPT TYPE : FIXTURE <br /> NOTE: WATF,R SOFTENER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> STATE SURCHARGE PLBG(<$500) 1.00 <br /> WATER DOCTORS TOTAL 16.00 <br /> 8201 CENTRAL AVENUE Payment(s) <br /> SPRING LAKE PARK,MN 55432- CREDIT CARD 6404 16.00 <br /> (763)535-1800 <br /> Minnesota State License#: mech-WC645002 <br /> OWNER <br /> CONNELLY,THOMAS <br /> 3115 NORTH SHORE DR <br /> WAYZATA, MN 55391- <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 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 /> shall 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 wi[hin 180 days of the date of 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 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 /> � <br /> ) � � Y� �`��'���/e1�CJ �� / � /! � <br /> Applicant Permitee Signature Date Iss ed Signature Date <br />