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CITY OF ORONO * z 0 1 5 - 0 0 6 1 7 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OS/18/2015 <br /> • ORONO, MN 55356- <br /> � 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 4215 NORTH SHORE DR <br /> PIN : 07-117-23-43-0006 <br /> LEGAL DESC : ORCHARD BEACH <br /> : LOT 002 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> NOTE: MOVE GAS LINE IS'FOR OUTDOOR GRILL <br /> APPLICANT MECHANICAL(<$500) 15.00 <br /> STATE SURCHARGE MECH(<$500) 5.00 <br /> HEINEN HEATING&A/C INC TOTAL 20.00 <br /> 9155 NOVEMBER DR Payment(s) <br /> ST.JOSEPH,MN 56374- CREDIT CARD 4031 20.00 <br /> (320)363-7813 <br /> Minnesota State License#:mech-004545 <br /> OWNER <br /> WALDOCH, DOUGLAS&DIANE <br /> 4215 NORTH SHORE DR <br /> MOLJND,MN 55364- <br /> AGREEME1vT 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 goveming this rype 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 ace <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> f�:� <br /> �..�,�,,,,, .��� .���-�- l�5 � �� " ��-- � � �c� ��i l��i <br /> Appli�t ermitee Signature ate Issued By Si nature Date <br />