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, <br /> , CITY OF ORONO * Z 0 1 4 - 0 P1 7 6 5 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/24/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952 249-4616 <br /> ADDRESS : 2655 NORTH SHORE DR <br /> PIN : 09-117-23-42-0001 <br /> LEGAL DESC : UNPLATTED 09 117 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : PLUMBING(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : WATER SOFTNER <br /> VALUATION OF PLUMBING 500 <br /> APPLICANT PLUMBING FIXTURE FEE 50.00 <br /> STATE SURCHARGE PLBG(VALUATION) 0.25 <br /> WATER DOCTORS MAIL-IN FEE 2.00 <br /> 8201 CENTRAL AVENUE TOTAL 52.25 <br /> SPRING LAKE PARK,MN 55432- <br /> (763)535-1800 Payment(s) <br /> Minnesota State License#: mech-WC645002 CREDIT CARD 7603 52.25 <br /> OWNER <br /> VAN RIEMSDYK,JAMES <br /> 2655 NORTH SHORE DR <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 sepazate <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 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> ��� / / <br /> Applicant Permitee Signature Date Issued By S' ture ,� i�ate <br /> �/ ��---� <br />