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. . � • CITY OF ORONO * 2 0 1 z - 0 0 7 3 z * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/3U2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 75 LEAF ST <br /> PIN : OS-117-23-11-0014 <br /> LEGAL DESC : GRAHAM HILL PRESERVE 3 <br /> : LOT 1 BLOCK 3 <br /> PERMIT TYPE : PLUMBING (<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURES- MULTIPLE <br /> NOTE: WATGR SOFTENER <br /> APPLICANT PLUMB[NG FIXTURE FEE(<$500) 15.00 <br /> WATER DOCTORS STATE SURCHARGE PLBG (<$500) 5.00 <br /> 8201 CENTRAL AVENUE <br /> SPRING LAKE PARK, MN 55432- TOTAL 20.00 <br /> (763)286-6243 <br /> Minnesota State License#: 082337 <br /> OWNER <br /> KAPSNER,JASON &JULIE <br /> 760 DICKEY LAKE ROAD <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 E3uilding Code. This permit is for only the work described and does <br /> not grant permission for additional or related work which requires separate <br /> permi[s. 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 /> expirc 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 fo due cause. <br /> � � � _ �7 ,3� � /Z- <br /> Applicant mitee Signa re Date Issu By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />