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PER, MIT <br /> CITY OF ORONO PERMIT TYPE: I AL <br /> 1335 Brown Rd. South • P.O. Box 66 IES`c 56`CAL <br /> Permit Number: i_ii_iti.._ _�_ <br /> Crystal Bay, Minnesota 55323 Date Issued: 08/11/92 <br /> (612) 473-7357 <br /> SITE ADDRESS: -----------------------_______ <br /> NORTHERN AVE <br /> LSV <br /> P. I . N. . 17-117-23-34-0013 <br /> DESCRIPTION: <br /> FURNACE/GAS LINE <br /> I HEATING SYSTEMS <br /> I GAS LINE INSPECT <br /> Lri! I 11! Vl ti! L' <br /> I 1 f('7 7(4L ijl!1Lf <br /> 1 Jl s1J1�VYVV} � <br /> _ !. /Yt 17L17 4'�!}s LSV! <br /> i�.LL�:_V�ltt��V _ T! <br /> REMARKS: �i y ifN -51i" <br /> L•!iL L•!\0 7L 3V•JV <br /> lCL 4L 1! 1 llfll tll I,VU� <br /> 4249i-'56,, L+061 fSVl I06•01 <br /> FEE SUMMARY: <br /> Base Fee $30. 00 <br /> Surcharge -----------aQ <br /> Total Fee $30. 50 <br /> CONTRACTOR: OWNER: - Applicant - <br /> BURNEVIK THOMAS <br /> 3630 NORTHERN AVE. <br /> ORONO MN 58391 <br /> (612)471-0024 <br /> THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS <br /> SPECIFIED AND AGREES TO I,-O ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF <br /> ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. <br /> L_ <br /> APPLICA ERMITEE SIGNATURE ISSUED BY:SIGNATURE C�� <br />