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'' ` + CITY OF ORONO <br /> 2750 KELLEY PARKWAY * z 0 1 2 - 0 0 2 8 3 * <br /> DATE ISSUED: 04/13/2012 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1629 BOHNS POINT RD <br /> PIN : 17-117-23-11-0005 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0565 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING (<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: RGPLACE WATER SOFTENER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <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 /> PA[D W[TH CC# 0597 <br /> OWNER <br /> GREEN,RANDALL <br /> 1629 BOHNS PT RD <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according ro <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 specitied herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> eommenced within]80 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 /> reques[ed in conform�nce with the State Building Code.7'his permit may be <br /> �revoked at a y time for due caus . <br /> Y.�i��-���� l l �%�,Lvt- �� �/J' �/:� <br /> Applicant�Permitee Signature DaCe Iss By Signature Date <br /> SEPARATE PERM[TS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />