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CITY OF ORONO * 2 0 1 6 - PJ 1 0 0 5 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 08/19/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 200 BAYSIDE TR <br /> PIN : 06-117-23-22-0027 <br /> LEGAL DESC : BAYVIEW FARMS 2ND ADDN <br /> : LOT 2 BLOCK 1 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATIOI�1 : $ 1,200.00 <br /> NOTE: ALL TESTMG REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> GAS LINE TO GENERATOR THROUGH FINISHED CELING SPACE UP TO 95' <br /> APPLICANT MECHANICAL 52.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.60 <br /> PRACTICAL SYSTEMS TOTAL 52.60 <br /> 4342B SHADY OAK RD <br /> HOPKINS, MN 55343 Payment(s) <br /> (952)933-1868 CHECK 8719 50.60 <br /> CHECK 8719 2.00 <br /> OWNER <br /> HOLLOWAY&MELISSA KUKLOK,CASS <br /> 200 BAYSIDE TR <br /> MAPLE PLAIN, MN 55359- <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 /> �- � j <br /> � - � <br /> C , <br /> - , _ /j - , ; r �l �.. C7� <br /> ---- ` � <br /> ' ✓l/ ' ` \. ' �1 ` �' � � � 1 / '((,. <br /> ' �le <br /> /c • . 'J 1�� �..4 � <br /> A�4plicant Permitee Signatu Date Issued y Signautt�e Date <br />