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0 "~, CITY OF ORONO 11111111111111111111110111111111111111111111111 <br /> * 2014 - 00894 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 08/13/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2760 WHITE OAK CIR <br /> PIN : 04-117-23-42-0018 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1447 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 600.00 <br /> NOTE: RECONNECT EXIJSTING GASLINE TO POOL <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH (VALUATION) 0.30 <br /> METRO GAS INSTALLERS TOTAL 50.30 <br /> 685 141ST LANE NW <br /> Payment(s) <br /> ANDOVER, MN 55304 <br /> (763)754-7119 CHECK 14884 50.30 <br /> Minnesota State License#: mech-MB003162 <br /> OWNER <br /> SHANNON,MR.&MRS. <br /> 2760 WHITE OAK CIR <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 ti e fo due cause. <br /> ..� l3 8 ,t 3-,� <br /> Ap icant Permitee Signature /z <br /> Date <br /> Issu By Signature Date <br />