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CITYOFORONO * 20 15 - 00286 * <br /> ,,.� 2750 KELLEY PARKWAY DATE ISSUED: 03/10/2015 <br /> , ORONO, MN 55356- <br /> 952) 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1165 FERNDALE RD W <br /> PIN : 02-117-23-43-0026 <br /> LEGAL DESC : NORTH SHORE COTTAGE ACRES LAKE <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> COI�ISTRUCTION TYPE : FIXTURES- MULTIPLE <br /> NOTE: WATER SOFTENER <br /> IRON FILTER <br /> RF,VGRSE OSMOSIS <br /> VALUATION OF PLUMBING 3900 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 1.95 <br /> CLEARWATER SYSTEMS, INC. TOTAL 51.95 <br /> 1519 148TH AVE NW Payment(s) <br /> ANDOVER, MN 55304 CHECK 34270 51.95 <br /> (763)434-0445 <br /> Minnesota State License#: plbg-61240 <br /> OWNER <br /> BROOK, ROBERT <br /> 1165 FERNDALE RD W <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 da s at any time after work has commenced. <br /> The applicant is responsibl r as uring all required inspections are <br /> requested in co f6'rman with t State Building Code.This permit may be <br /> revoked a y time r e c <br /> ( ' <br /> �. /� <br /> i�� /v � �� Lf '-�i /� � !S <br /> � icant i ee gnature Da Issu.e�d By Signature Date <br />