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, CITY OF ORONO * Z 0 1 6 - 0 1 2 4 5 * <br /> ' '� 2750 KELLEY PARKWAY <br /> DATE ISSUED: 09/30/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : '758 BRIDGEWATER DR <br /> PIN : 33-118-23-11-0133 <br /> LEGAL DESC : STONEBAY FOURTH ADDITION <br /> : LOT 16 BLOCK 1 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 800.00 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECT[ON. <br /> GASLINE FOR(2)FIREPLACES-ONE ON MIAN AND ONE ON LOWER LEVEL <br /> APPLICANT MECHAN[CAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.50 <br /> SCHULTIES PLUMBING MAIL-IN FEE 2.00 <br /> 1521 94TH LANE NE <br /> BLAINE, MN 55449 TOTAL 52.50 <br /> (651)786-4007 Payment(s) <br /> Minnesota State License#: plbg-PC644177,mech-MB005379 CHECK 33720 52.50 <br /> OWNER <br /> Stonebrook Development LLC <br /> 17149 LINCOLN ST NE <br /> HAM LAKE, MN 55304- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specitications,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 l80 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 /> requestcd in conformance with the State Building Code.This permit may be <br /> revoked at any time for d�e cause. <br /> D �I�e ' � 9 , �� ! � <br /> Applicant Permitee Signature Date Issued B ignature Date <br />