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I . � <br /> � . CITY OF ORONO * z 0 1 2 — 0 0 e 1 4 * <br /> I ;" + 2750 KELLEY PARKWAY DATE ISSUED: 08/20/2012 <br /> ���� � ORONO, MN 55356- ' <br /> ; <br /> - (952) 249-4600 FAX: (952) 249-4616 <br /> �.�s"�RESS : 335 HOLLANDER RD <br /> ��"I�`�-, : 25-118-23-43-0009 <br /> i'.E-"�AL DESC : REG. LAND SURVEY NO. 1429 <br /> f <br /> . : LOT 000 BLOCK 000 <br /> r'F,;"MIT TYPE : MECHANICAL(<$500) <br /> �'R"';PERTY TYPE : RES[DENTIAL <br /> �'C`'fSTRUCTION TYPE : GAS LINE ONLY - � <br /> ._` � <br /> i <br /> ; O'�3: GAS LINE FOR RANGE i <br /> '<rr <br /> i <br /> . ;;: <br /> :�;. <br /> �q <br /> APPLICANT MECHAN[CAL(<$500) 15.00 <br /> �:�P ��A HOAGLAND PLUMBING INC <br /> , l�lfi ZEGENCY LANE W STATE SURCHARGE MECH(<$500) 5.00 <br /> ���IG KINS, MN 55343- TOTAL 20.00 � <br /> ���`"' 935-5150 <br /> y. <br /> � <br /> OWNER <br /> �R; ",KSON, WALTER&NANCY Z <br /> ':3` '�OLLANDER RD <br /> �'�:',''ZATA, MN 55391 <br /> � <br /> , AGREEMENT AND SWORN STATEMENT <br /> 'hc��✓ork for which this permit is issued shall be performed according to i <br /> he;:;iproved pians and specifications,applicable City approvals,and the <br /> ,,lta�, �$uilding Code. This permit is for only the work described and does <br /> •io� --ant permission for additional or related work which requires separate <br /> ;�e�"-''ts. AII provisions of laws and ordinances governing this type of work <br /> �ha:'-be compied�aith whether or not specified herein.This permit will <br /> .x;i �and become null and void if construction authorized is not <br /> oir nenced within 180 days of the date of issuance,or if construction is <br /> �u�4; nded for a period of I 80 days at any time after work has commenced. <br /> L...pplicant is responsible for assuring all required inspec[ions are ''w <br /> ;c;i*' sted in conforniance with the State Building Code.This permit may be <br /> ;ev- ed at any time for due cause. �!� � <br /> ,( �u� <br /> ���� <br /> - _ - i zo i i�.. � l�--^ . � c t=�,;�,C �� i i �� <br /> �;�p,_.icant Permitee Signat Date [ssued By Signature Date � <br /> ''`� SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br /> _, >,�, <br />