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f� CITY OF ORONO * 2 0 1 5 - 0 0 2 4 1 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: OZ/26/2015 <br /> ORONO,MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2496 SANDSTONE LA <br /> PIIv : 33-118-23-11-0023 <br /> LEGAL DESC : STONEBAY <br /> : LOT 020 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 1,000.00 <br /> NOTE: GAS LINES:2 FIREPLACES, 1 RANGE, 1 DRYER <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.50 <br /> SCHULTIES PLUMBING MAIL-IN FEE 2.00 <br /> 1521 94TH LANE NE <br /> BLAINE,MN 55449 TOTAL 52.50 <br /> (651)786-4007 Payment(s) <br /> Minnesota State License#:plbg-058799PM,mech-MB005379 CHECK 33205 52.50 <br /> OWNER <br /> Wooddale Builders Inc. <br /> 6117 BLUE CREEK DR <br /> SUITE 101 <br /> MINNETONKA,MN 55343- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be perfortned 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 dces <br /> not grant permission for additional or related work which requires separate <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 are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. /n„„ <br /> /(,�// <br /> � � -�_ C.��'� � / `t('/ � <br /> Applicant Permitee Sign ture Date Issued By Signature Date <br />