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� � <br /> - CITY OF ORONO * Z 0 1 3 - 0 1 2 z 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 1U18/2013 <br /> � ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952)249-4616 <br /> ADDRESS : 3515 SIXTH AVE N <br /> PIN : 29-118-23-43-0002 <br /> LEGAL DESC : UNPLATTED 29 118 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 300.00 <br /> NOTE: GAS LINE TO COOKTOP <br /> APPLICANT MECHANICAL 50.00 <br /> MANATEE PLUMBING STATE SURCHARGE MECH(VALUATION) 0.15 <br /> 11525 199TH CIRCLE TOTAL 50.15 <br /> SILVER LAKE, MN 55381- <br /> (612)756-1172 PAID WITH CC# 8468 <br /> Minnesota State License#: 005923PM <br /> OWNER <br /> PETERSON,DALE&DIANE <br /> 3515 SIXTH AVE N <br /> LONG LAKE,MN 55356- <br /> AGREEME1vT 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 sepazate <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 /> r at any ti r due <br /> /( / ��/ � / / <br /> Applicant Permitee Signature Date Issued By ature ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB . <br />