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T �' CITY OF ORONO * 2 0 1 6 — 0 0 1 5 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 02/i U2016 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1790 SHADYWOOD RD <br /> PIN : 17-117-23-21-0025 <br /> LEGAL DESC : SHADY-WOOD <br /> : LOT 020 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 1,495.00 <br /> NOTE: GASLINE TO RANGE,BASEMENT FIREPLACE,AND MAIN LEVEL FIREPLACE <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.75 <br /> STEWART PLUMBING,INC. MAIL-IN FEE 2.00 <br /> 13025 GEORGE WEBER DR <br /> SUITE#1 TOTAL 52.75 <br /> ROGERS,MN 55374 Payment(s) <br /> (763)428-1833 CREDIT CARD 3122 52.75 <br /> Minnesota State License#:plbg-PC000474,mech-MB003262 <br /> OWNER <br /> MATEFFY,JOSH&CAITI <br /> 1790 SHADYWOOD 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 I80 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 /> � �� <br /> Applicant Permitee Signature Date Issue B ignature Date <br />