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� ' CITY OF ORONO * z 0 1 4 - 0 1 0 1 5 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/10/2014 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: 952)249-4616 <br /> ADDRESS : 1376 PARK DR <br /> PIN : 07-117-23-41-0096 <br /> LEGAL DESC : -SA�A-HILZ 1�VIS , _----------------------- --- <br /> �Y___----- -- <br /> : LOT MB BLOCK 013 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER SOFTNER <br /> NOTE: 1 WATER SOF'TNER <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 /> CREDIT CARD 8645 22.00 <br /> OWPTER <br /> LARSON&TERESA,DAYTON <br /> 1376 PARK DR <br /> MOUND,MN 55364 <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 goveming 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 within 180 days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time aRer 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 /> � � � C� � ,cc� , <br /> Applicant Permitee Signature Date ssued Signature Date <br />