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� • � <br /> CITY OF ORONO * Z 0 1 4 - 0 0 9 7 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/29/2014 <br /> ORONO,MN 55356- <br /> (952 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3360 SHORELINE DR <br /> PIN : 17-117-23-44-0101 <br /> LEGAL DESC : TOWNSITE OF LANGDON PARK <br /> : LOT 005 BLOCK 003 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : COMMERCIAL-BUSINESS <br /> CONSTRUCTION TYPE : FUEL STORAGE TANK <br /> VALUATION : $ 44,818.67 <br /> NOTE: UNDERGROUND FUEL STORAGE-4,000 GALLONS-GAS <br /> APPLICANT MECHANICAL 560.23 <br /> STATE SURCHARGE MECH(VALUATION) 22.41 <br /> PUMP&METER SERVICES TOTAL 582.64 <br /> 11303 EXCELSIOR BLVD. Payment(s) <br /> HOPKINS,MN 55343 <br /> (952)933-4800 CHECK 27222 582.64 <br /> OWNER <br /> Navarre Service Station <br /> KOEHNEN,LEROY <br /> 3360 SHORELINE <br /> NAVARRE,MN 55392- <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 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. <br /> C ���� , �. � , 29, � <br /> Applicant Permitee Sign Date Is ed By Signature Date <br />