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,`, - <br /> CITY OF ORONO * Z 0 1 2 — fd 1 0 7 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/24/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 75 FERNDALE RD N <br /> PIN : 36-118-23-44-0006 <br /> LEGAL DESC : ALLO-RAE TERRACE <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : PLUMBING (<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER SOFTNER <br /> NO"1'E: REPLACE WA"CF,R SOF"I�F,NF,R <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 /> PAID WITH CC# 0597 <br /> OWNER <br /> BRINKMAN, MR. & MRS. <br /> 75 FERNDALE RD. N <br /> WAYZATA, MN 55391 <br /> AGREEMENT AND SWORN STATEMENT <br /> The ti�ork for which this permit is issued shall be performed according to <br /> the approved plans and specifications,appGcable 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 oY 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 after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance wi[h the State Building Code.This permit may be <br /> revoked at any time for due c se. <br /> l� �a�/� l� i� �� ��a� <br /> Applicant Permitee Si re Date �s By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />