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CITY OF ORONO �I 'II11111111 I 1' ! 1 ' <br /> * 2 0 1 5 - 0 0 5 4 6 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 05/06/2015 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2160 WAYZATA BLVD W <br /> PIN : 34-118-23-21-0002 <br /> LEGAL DESC : UNPLATTED 34 118 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 1,000.00 <br /> NOTE: RECONNECT GAS TO NEW METER INSTALLATION GAS LINE TO FIREPLACE <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.50 <br /> MATRIX HVAC TOTAL 50.50 <br /> 14226 NORDEN DR <br /> ROGERS,MN 55374- Payment(s) <br /> CREDIT CARD 6412 50.50 <br /> (763)535-6335 <br /> Minnesota State License#: mech-MB0036761 <br /> OWNER <br /> Orono Station West <br /> ERICKSON,BRAD <br /> 2486 BOBOLINK RD <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 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 cause. <br /> IC <br /> Ap 'cant Permitee Signature Date Issued By Signature Date <br />