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CITY OF ORONO 'I I' <br /> * 2 0 1 5 - 0 0 4 7 9 <br /> 2750 KELLEY PARKWAY DATE ISSUED: 04/24/2015 <br /> _ <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 625 FERNDALE RD N <br /> PIN : 36-118-23-11-0021 <br /> LEGAL DESC : UNPLATTED 36 118 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 4,100.00 <br /> NOTE: GASLINE TO OUTDOOR GRILL,TO POOL HEATER,AND BACK TO HOUSE <br /> APPLICANT MECHANICAL 51.25 <br /> STATE SURCHARGE MECH(VALUATION) 2.05 <br /> METRO GAS INSTALLERS TOTAL 53.30 <br /> 685 141ST LANE NW <br /> ANDOVER,MN 55304 Payment(s) <br /> (763)754-7119 CHECK 15348 53.30 <br /> Minnesota State License#: mech-MB003162 <br /> OWNER <br /> GLAD,CARSON&KAROLIEN <br /> 625 FERNDALE RD N <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 fo due cause. <br /> ��g4—(— 5 fi- d2:14/(--61.----A _ l 0,2'74 /,5— <br /> App icant Permitee tgnature Date Issued By Snature Date <br />