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CITY OF ORONO * Z 0 1 6 — fd 0 4 4 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 04/28/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 787 BOULDER DR <br /> PIN : 33-118-23-11-0132 <br /> LEGAL DESC : STONEBAY <br /> : LOT 7&8 BLOCK 1 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY , <br /> VALUATION : $ 1,300.00 <br /> NOTE: GASLINE FOR 2 GAS FIREPLACE, 1 RANGE AND 1 DRYER <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.65 <br /> SCHULTIES PLUMBING MAIL-IN FEE 2.00 <br /> 1521 94TH LANE NE <br /> BLAINE,MN 55449 TOTAL 52.65 <br /> (651)786-4007 Payment(s) <br /> Minnesota State License#:plbg-PC644177,mech-MB005379 CHECK 33597 52.65 <br /> OWNER <br /> Wooddale Builders <br /> 6117 BLUE CIR DR <br /> MINNETONKA, MN 55343- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according ro <br /> [he 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 /> shal)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 afrer 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 due cause. <br /> � �� ) � Z£s/ / C� <br /> Applicant Permitee Signature Date Issued By gnature Date <br />