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' � ' CITY OF ORONO * z 0 1 5 - 0 1 0 1 z * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 08/10/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2655 COUNTRYSIDE DR W <br /> PIN : 04-117-23-13-0006 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 006 BLOCK 003 <br /> PERMIT TYPE : MECHAN[CAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 2,850.00 <br /> NOTE: GASLINE TO A POOL HEATER AND OUTDOOR GRILL <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 1.43 <br /> METRO GAS INSTALLERS TOTAL 51.43 <br /> 685 141ST LANE NW Payment(s) <br /> ANDOVER, MN 55304 CHECK 15606 51.43 <br /> (763)754-7119 <br /> Minnesota State License#: mech-MB003162 <br /> OWNER <br /> VOSSEN, MICHAEL&KATHLEEN <br /> 2655 COUNTRYSIDE DR W <br /> LONG LAKE, MN 55356- <br /> AGREEME1vT 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. AII provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specified herein.This permi[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[ime after work has commenced. <br /> The applicant is responsible for assuring all required inspec[ions are <br /> requested in conformance wi[h the State Building Code.This permit may be <br /> revoked at any time for due c use. <br /> /,� • <br /> � I �' �' ��-S p �� � i/� i�.S <br /> Applica ermitee Signature Date Issued y Signature Date <br />