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CITY OF ORONO * 2 0 1 6 — 0 0 9 0 9 * <br /> ' 2750 KELLEY PARKWAY DATE ISSUED: 08/OU2016 <br /> ' ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> Anniz��:ss : 2710 KELLY AVE <br /> p1N : 21-117-23-23-0034 <br /> LF,GAI.1)ESC : VERN-MARMANOR <br /> : LOT 009 BLOCK 000 <br /> PERMI'I'TYPE : MECHANICAL � <br /> P1201'I:RTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUAT[ON : $ 1,685.00 <br /> NOT�: nT.,I,TGSTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> RUNNIN�� A NEW GAS LINE TO METER AND A RANGE GAS LINE <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.84 <br /> PRON"CO t I LATING&AC TOTAL 50.84 <br /> 7415 CA[1[LL RD Payment(s) <br /> EDINn, MN 55439- CHECK 12247 50.84 <br /> (952)835-7777 <br /> OWIVER <br /> RES'1'OR�"I'ION,ROBIN <br /> 2080 SI IOIZELINE DR <br /> WnY7_.nTn,MN 55391- <br /> AC 12EF.MENT AND SWORI�I STATEMENT <br /> The work fix which this permit is issued shail be performed according to <br /> the approvcd plans and specifications,applicable City approvals,and the <br /> State I3uilding Code. This permit is for only the work described and dces <br /> not grant pcnnission for additional or related work which requires separate <br /> permits. nll provisions of laws and ordinances governing this type of work <br /> shall hc compicd with whether or not specified herein.This permit will <br /> cs�'rc,n�cl h�-c�,mc null and void if construction authorized is not <br /> co;�„c,� ��,I ����ihin 180 days ofthe date of issuance,or if construction is <br /> su.,•nd�I G�r a period of 180 days at any time after work has commenced. <br /> "Il: �;,I :;nt is respo isible for assuring all required inspections are <br /> rcq �rr� in cnnfonn�ce with the State Building Code.This permit may be <br /> �v�k�d; an� time for due cause. ��'/ <br /> � <br /> � I� c� ��-���� �� � �lC� <br /> ppl� n a�mit e Sign ture ate Issued By Signature Date <br />