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CITY OF ORONO * Z 0 1 6 - 0 1 1 5 1 * <br /> � 2750 KELLEY PARKWAY <br /> DATE ISSUED: 09/20/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 333 HOLLANDER RD <br /> PIN : 25-118-23-43-0005 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1281 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 3,500.00 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL[NSPECTION. <br /> ROUGH-IN THRU HOUSF,TO FUTURE POOL HEATER <br /> APPLICANT MECHAN[CAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 1.75 <br /> METRO GAS INSTALLERS TOTAL 51.75 <br /> 685 141ST LANE NW Payment(s) <br /> ANDOVER, MN 55304 CHECK 16286 51.75 <br /> (763)754-7119 <br /> Minnesota State License#: mech-MB003162 <br /> OWNER <br /> TANNER,JOHN&DONNETTE <br /> 333 HOLLANDER RD <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 after 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 /> � �,d -" / � J � � /�D / /(� <br /> App cant Permitee Signature Date Issued Signature Date <br />