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11111111111111111111111111H <br /> CITY OF ORONO * 2 0 1 4 - 0 0 2 0 1 <br /> 2750 KELLEY PARKWAY DATE ISSUED: 03/12/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS 684 TONKAWA RD <br /> PIN 05-117-23-33-0011 <br /> LEGAL DESC PARTENS POINT I ST DIV <br /> LOT 000 BLOCK 000 <br /> PERMIT TYPE PLUMBING(<$500) <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE WATER SOFTNER <br /> APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 <br /> CULLIGAN SOFT WATER SERVICE CO. <br /> STATE SURCHARGE PLBG(<$500) 5.00 6030 CULLIGAN WAY MAIL-IN FEE 2.00TOTAL 22.00 <br /> MINNETONKA,MN 55345 <br /> (952)912-7379 Payment(s) <br /> CREDIT CARD 8645 22.00 <br /> OWNER <br /> GILBERTSON, WELDON&MARCIA <br /> 684 TONKAWA RD <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 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 cause. <br /> Applicant Permitee Signature Date Issued B ignature Date <br />