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CITY OF ORONO I* 2 0 1 5 (- 0 0 31 SI I41 �'*I <br /> 2750 KELLEY PARKWAY DATE ISSUED: 03/30/2015 <br /> ORONO, MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 450 OLD LONG LAKE RD <br /> PIN : 36-118-23-34-0014 <br /> LEGAL DESC : SUMMIT STATION <br /> : LOT 007 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 4,000.00 <br /> NOTE: GASLINE FOR FIREPLACE <br /> VENT(1)KITCHEN EXHAUST <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 2.00 <br /> WILLIAM H.GILBERTSON LLC TOTAL 52.00 <br /> 5910 HAWTHORNE RD Payment(s) <br /> MOUND,MN 55364- CHECK 5647 52.00 <br /> (612)702-3428 <br /> OWNER <br /> POLICINSKI,CHRISTOPHER&ANNE <br /> 450 OLD LONG LAKE RD <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 for due cause. <br /> 3/)///5 <br /> Applicant Permitee Signature D IssueBy Signature Date <br />