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CITY OF ORONO III I II II I II 11111111 IIIIII <br /> * 20 1 2 - 00 1 S3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 02/22/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4550 WOLVERTON PL <br /> PIN : 31-118-23-31-0005 <br /> LEGAL DESC : FOXFYRE ESTATES <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(<$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> NOTE: RUNNING GASLINE ONLY FOR FIREPLACE <br /> APPLICANT MECHANICAL(<$500) 15.00 <br /> G-HVAC STATE SURCHARGE MECH(<$500) 5.00 <br /> 16036 MALLARD WAY SE <br /> PRIOR LAKE,MN 55372- TOTAL 20.00 <br /> (612)619-9322 PAID WITH CC# 9457 <br /> OWNER <br /> STEPHENSON, REVIS L <br /> 4550 WOLVERTON PL <br /> MAPLE PLAIN, MN 55359- <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 /> revoke at any time for due cause. <br /> 2-/ ?-2112,_ <br /> (44,&_ � <br /> Applicant rmitee Signature Date Issued <br /> y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />