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Y <br /> CITY OF ORONO * Z 0 1 5 - 0 1 4 3 6 * <br /> < 2750 KELLEY PARKWAY DATE ISSUED: 1U09/2015 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 258 CYGNET PL <br /> PIN : 04-117-23-23-0019 <br /> LEGAL DESC : SWAN LAKE ADDN <br /> : LOT O10 BLOCK 003 <br /> PERMIT TYPE : PLUMBING (<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER SOFTENER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) I5.00 <br /> STATE SURCHARGE PLBG (<$500) 1.00 <br /> CULLIGAN SOFT WATER SERVICE CO. MAIL-IN FEE 2.00 <br /> 6030 CULL[GAN WAY <br /> MINNETONKA, MN 55345- TOTAL 18.00 <br /> (952)912-7379 Payment(s) <br /> CREDIT CARD 8645 18.00 <br /> OWIYER <br /> HUBBARD,ANNIE <br /> 258 CYGNET PL <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 specifications,applicable City approvals,and the <br /> State Building Code. This permit is for only[he 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 construetion 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 /> �� � i , � � C�� <br /> I c� �`l-�� �� � � � � ��� <br /> Applicant Permitee Signature Date [ssued By.'ignature . Date <br />