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. ., CITY OF ORONO * 2 0 1 4 — 0 0 9 9 2 * <br /> 2750 KELLEY PARKWAY DA'rE [SSUE�: 09/03/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2630 COUNTRYSIDE DR W <br /> PIN : 04-117-23-12-0015 <br /> LEGAL DF,SC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 007 BLOCK 002 <br /> PERMIT TYPE : MF_CHANICAL(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> NOTE: GASLINE TO 1'IREPLACI;- I ST FLOOR <br /> APPLICANT MECHANICAL(<$500) I5.00 <br /> STATE SURCHARGE MECH(<$500) 5.00 <br /> PROMECI-1 LLC TOTAL 20.00 <br /> 121 ]0 IDAHO AVE N <br /> CHAMPLIN, MN 55316- Payment(s) <br /> (612)518-3066 CHECK 7956 20.00 <br /> OWNER <br /> URNESS, TODD& KATHERINE <br /> 2630 COUNTRYSIDE DR W <br /> LONG LAKE, MN 55356 <br /> ACREEMF,NT AND SWORN STATEMENT <br /> I�he work for which this permit is issued shall be performed aecording to <br /> the approved plans and specifica[ions,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 nol specified herein.'I�his permit will <br /> expire and becoiroe null and void if construction authorized is not <br /> commenced within 180 days of[he date of issuance,or if construction is <br /> suspended for a period of 180 days at any time after work has commenced. <br /> Ihe applicant is responsiblc for assuring all required inspections are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at anv time for due cause. <br /> -`" � �� 9' i �- i �f <br /> App ' a ermitce Signature Date Issue y Signature Date <br />