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X <br /> CITY OF ORONO I I F 1 [ I 11 Ii 11 11 � I i 111 <br /> ' <br /> 2750 KELLEY PARKWAY * 2 1 7 - 0 1 <br /> DATE ISSUED: 10/10/2017 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 820 OLD CRYSTAL BAY RD S <br /> PIN : 04-117-23-43-0008 <br /> LEGAL DESC : AUDITOR'S SUBD.NO.229 <br /> : LOT 027 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 2,850.00 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> GASLINE FOR POOL HEATER AND OUTDOOR FIRE PIT <br /> APPLICANT MECHANICAL 50.00 <br /> METRO GAS INSTALLERS STATE SURCHARGE MECH(VALUATION) 1.43 <br /> 685 141ST LANE NW TOTAL 51.43 <br /> ANDOVER,MN 55304 Payment(s) <br /> (763)754-7119 CHECK 16972 51.43 <br /> Minnesota State License#:mech-MB003162 <br /> OWNER <br /> FREES,KEATON&HANS <br /> 820 OLD CRYSTAL BAY RD S <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 f due cause. <br /> /O-10—/7 ke %1/ X01 /01 /7 <br /> Ap ican Petmite ignature Date Issued B ignature Date <br />