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� � CITY OF ORONO * 2 0 1 Z — fd 0 9 6 5 * <br /> 2750 KELLEY PARKWAY �ATE issuEn: 09/27/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1900 FOX R[DGE RD <br /> PIN : 03-117-23-13-0009 <br /> LEGAL DESC : FOX RIDGE <br /> : LOT 005 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(> $500) <br /> NRONERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 900.00 <br /> NO"[�E: GASL[NE FOR A POOL HEATER <br /> APPLICANT MECHANICAL 50.00 <br /> METRO GAS INSTA[,LERS STATE SURCHARGE MECH(VALUATION) 0.45 <br /> 685 141ST LAN E N W TOTAL 50.45 <br /> ANDOVER, MN 55304 <br /> (763)754-71 19 <br /> OWNER <br /> LINDQUIST, RUSTY & SHANNON <br /> 1900 FOX RIDGE RD <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> Thc�+�ork for which this permit is issued shall be performed according to <br /> thc approved plans and specitications,applicable City approvals,and thc <br /> State[3uilding Code. This pern�it is for only the work describcd and does <br /> not grant permission for additional or related work which requires separatc <br /> permits. All provisions of laws and ordinances goveming this type of work <br /> shali be compied wilh whether or not specified herein.This permit will <br /> expirc 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 after work has commenced. <br /> Thc applicant is responsible for assuring all required inspections are <br /> requcsted in conf man with the State B il ing Code.This permit may be <br /> revoked at a� � e t' due c � , <br /> -� �� �� �/`� � � <br /> � � �-� � ,��� `� /a` <br /> Appl' ant Permitee Signature Date Issu v Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />