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. .. <br /> � CITY OF ORONO * 2 0 1 6 - 0 1 4 1 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 1ll08/2016 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952)249-4616 <br /> ADDRESS : 2195 SHADYWOOD RD <br /> PIN : 17-117-23-43-0135 <br /> LEGAL DESC : WILEYS PARK LAKE MTKA <br /> : LOT 007 BLOCK 002 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FUEL STORAGE TANK <br /> VALUATION : $ 3,350.00 <br /> NOTE: 1,000 GALLON UNDERGROUND TANK-ABANDON IN PLACE <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 1.68 <br /> DEAN'S TANK INC. MAIL-IN FEE 2.00 <br /> P.O. BOX 22515 <br /> ROBBINSDALE,MN 55422 TOTAL 53.68 <br /> (763)535-0194 Payment(s) <br /> Minnesota State License#:BUIL-475 CREDIT CARD 8979 53.68 <br /> OWNER <br /> DUSSAUT,MARIE <br /> 2195 SHADYWOOD RD <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 /> permiu. All provisions of la�vs and ordinances goveming this rype 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 /> ' �� //i � i/� <br /> Applicant Per itee Signature Date Issued Signature Date <br />