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CITY OF ORONO * 2014 - 01164 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/08/2014 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS 200 TRUFFULA TR <br /> PIN 33-118-23-44-0039 <br /> LEGAL DESC MEADOW WOOD POND <br /> LOT 005 BLOCK 001 <br /> PERMIT TYPE MECHANICAL <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 500.00 <br /> NOTE: GASLINE FOR POOL HEATER <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.25 <br /> MELGAARD SERVICES TOTAL 50.25 <br /> 6726 ESTES AVE.NW Payment(s) <br /> MAPLE LAKE,MN 55358- CHECK 2125 50.25 <br /> (763)286-9896 <br /> Minnesota State License#:mech-MB643 5 3 8 <br /> OWNER <br /> ADAMS,DONALD&SHEILA <br /> 200 TRUFFULA TR <br /> LONG LAKE,MN 55356- <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 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 /> Applicant Permitee Signature Date Issued By Signature Date <br />