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` CITY OF ORONO * 2 0 1 8 - 0 a 2 1 2 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 02/27/2018 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 2695 SHADYWOOD RD <br /> PIN : 21-117-23-24-0056 <br /> LEGAL DESC : CHAPMAN ADDN <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 1,500.00 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> GASLINE FOR RANGE <br /> 1 R/A REPLACE AND 1 S/A REPAIR <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.75 <br /> PRACTICAL SYSTEMS MAIL-IN FEE 2.00 <br /> 4342B SHADY OAK RD <br /> HOPKINS,MN 55343 TOTAL 52.75 <br /> (952)933-1868 Payment(s) <br /> Minnesota State License#:mech-MB003510 CREDIT CARD 0097 52.75 <br /> OWNER <br /> PAULSON,STEPHEN&BOTHAINA <br /> 2695 SHADYWOOD RD <br /> EXCELSIOR,MN 55331- <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 Ciry 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 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 /> � <br /> D � ,� ���' <br /> Applicant Permitee ignature Date Issued By ► ature Date <br />