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CITY OF ORONO �! I I I'II !� I'! <br /> * 20 1 3 - 00 1 08 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 02/19/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 450 OLD LONG LAKE RD <br /> PIN : 36-118-23-34-0014 <br /> LEGAL DESC : SUMMIT STATION <br /> : LOT 007 BLOCK 001 <br /> PERMIT TYPE : PLUMBING(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> NOTE: 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, N 55345 MAIL-IN FEE 2.00 <br /> M <br /> (952)912-7379 MISC FEE 0.00 <br /> TOTAL 22.00 <br /> PAID WITH CC# 0597 <br /> OWNER <br /> POLICINSKI,CHRISTOPHER&ANNE <br /> 450 OLD LONG LAKE RD <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 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 with the State Building Code.This permit may be <br /> revoked at any time for due use. <br /> (nut? <br /> « it dr/ I Atitit_ OZ-/ /9 i, 3 <br /> Applicant Permitee Signature Date Issu:i a y ignature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />