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� CITY OF ORONO <br /> ., * 2 0 1 4 - 0 0 5 5 5 * <br /> 2750 KELLEY PARKWAY pATE �SSUED: 06/03/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2690 FOX ST <br /> PIN : 04-117-23-42-0003 <br /> LEGAL DESC : AUDITOR'S SUBD. NO. 229 <br /> : LOT 000 BI.,OCK 000 <br /> NERMIT TYPE : MECHAN[CAL(> $500) <br /> PROPERTY TYPE : RFSIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATIOIV : � 2,800.00 <br /> NO"I�I;: R[�'�'NING G:1S1.1V�I:"I�(> POOL f IEATI�,R,TO n ['IRI;NLi1Cl�:AND OUTDOOR GRILL <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH (VALUATION) 1.40 <br /> ME"I'RO GAS INSTALLERS TOTAL 51.40 <br /> 685 141ST LANE NW <br /> ANDOVER, MN 55304 Payment(s) <br /> (763)754-71 19 CHF;CK 14713 51.40 <br /> Minnesota State License#: mech-MF3003162 <br /> OWNER <br /> JACOBSON, MICHAEL <br /> 2690 FOX ST <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATF.MENT <br /> I�he work for ti�hich this permit is issued shall be perfornred accordine to <br /> thc approved plans and specifications,applicable City approvals,and thc <br /> State[3uilding Code. This permit is for only the work describcd and does <br /> not grant permission for additional or related work which requires separate <br /> pennits. All provisions of laws and ordinances govcrning this typc of work <br /> shall be compied with whether or not speci�ied herein.'�his permit will <br /> expire and become null and void if construction authorized is not <br /> commenced wiUiin 180 days of thc date of issuance,or if construction is <br /> suspcndcd t�or a period of 180 days at any time after work has commenced. <br /> �I�he�ippiicant is responsible for assuring all required inspections are <br /> requested in conformance w�h the State I3uil ' g Codc.This permit may he <br /> revoked al a�rv timc or d cause. / <br /> �' �� � �J��� � 3 / <br /> i i <br /> ,lpplicant Permitee Signature Date Issucd ���Signaturc Date � <br />