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CITY OF ORONO * Z 0 1 5 — 0 0 5 1 0 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OS/06/2015 <br /> � ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4205 FOREST LAKE DR <br /> PIN : 07-117-23-12-0027 <br /> LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN <br /> : LOT 005 BLOCK 003 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FUEL STORAGE TANK REMOVAL <br /> VALUATION : $ 1,950.00 <br /> NOTE: INSPECTIONS ARE DONE BY FIRE MARSHALL,JAMES VAN EYLL. <br /> PLEASE CALL JAMES VAN EYLL DIRECTLY AT:(952)473-9701 TO SET UP AN INSPECTION. <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.98 <br /> DEAN'S TANK INC. TOTAL 50.98 <br /> P.O. BOX 22515 Payment(s) <br /> ROBBINSDALE, MN 55422 CREDIT CARD 1599 50.98 <br /> (763)535-0194 <br /> Minnesota State License#: BUIL-475 <br /> OWNER <br /> LEMIRE,JEROME <br /> 4205 FOREST LAKE DR <br /> MOUND, MN 55364 <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 sepazate <br /> permits. All provisions of laws and ordinances governing this rype of wotk <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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> ��.� <br /> } �..,. <br /> � a� c L_. `�� � `_ �_ � y.�c� �, � J_, � �,._ � r � <br /> Applicant Permitee Signature ate [ssued By Signature Date <br />