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T' ,. CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 8 - 0 PJ 0 8 1 * <br /> DATE ISSUED: OU23/2018 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2780 SHADYWOOD RD <br /> PIN : 21-117-23-24-0041 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1196 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 480.00 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON S[TE AT F[NAL INSPECTION. <br /> GASLINE FOR COOKTOP <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 024 <br /> WELTER& BLAYLOCK 1NC. TOTAL 50.24 <br /> 307 PERSHING AVE.N Payment(s) <br /> NEW PRAGUE,MN 56071 CREDIT CARD 5704 50.24 <br /> Minnesota State License#:plbg-PM65425,mech-7900379583 <br /> OWNER <br /> CARTER, RICHARD&JEANNE <br /> 2780 SHADYWOOD RD <br /> EXCELSIOR, MN 55331- <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 afrer 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 f due cause. � <br /> � � � / , ,�, / _ <br /> Appli nt P mit Si ature Date Issued By Signa re Date <br />