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r CITY OF ORONO * z 0 1 7 - 0 0 7 0 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/26/2017 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2780 COUNTRYSIDE DR W <br /> PIN : 04-117-23-12-0010 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 002 BLOCK 002 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIXTURE <br /> VALUATION : $ 500.00 <br /> NOTE: REAPLCE GAS DRYER <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.25 <br /> MN PLUMBING&APPLIANCE INC. NIAIL-IN FEE 2.00 <br /> 14105 RUTGERS STREET NE <br /> PRIOR LAKE,MN 55372- TOTAL 52.25 <br /> (952)469-8341 Payment(s) <br /> Minnesota State License#:cont-58455-PM CHECK 9054 52.25 <br /> OWNER <br /> PETERSON,TIM <br /> 2780 COUNTRYSIDE DR W <br /> LONG LAKE,MN 55356- <br /> AGREEMENT AIVD 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 dces <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances goveming 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 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 /> � � � ,a�,l 7 <br /> Applicant Permitee Signature Date Issued ignature Date <br />