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. CITY OF ORONO * Z 0 1 6 — 0 0 5 9 0 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OS/25/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1825 CONCORDIA ST <br /> PIN : 17-117-23-22-0015 <br /> LEGAL DESC : COFFEES ADDN TO SHADY WOOD LAK <br /> : LOT 008 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 700.00 <br /> NOTE: GASLINE FOR A F[RE PIT. <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.35 <br /> ANGELL AIRE INC. MAIL-IN FEE 2.00 <br /> 12253 N[COLLET AVE <br /> BURNSVILLE,MN 55337 TOTAL 52.35 <br /> (952)746-5200 Payment(s) <br /> Minnesota State License#: mech-MB003386 CHECK 10870 5235 <br /> OW NER <br /> WING,JOHN&LISA <br /> 1825 CONCORDIA ST <br /> WAYZATA, MN 55391- <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 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 /> , �/'r' �',,�'�' �/z.5 /�� ^ -c� L� J� ��i /;�o <br /> f� /,�� / <br /> Applicant Permitee Signature Date [ssued Signature Date <br />