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CITY OF ORONO * z 0 1 4 — 0 0 5 9 3 * <br /> „ 2750 KELLEY PARKWAY DATE ISSUED: 06/12/2014 <br /> ORONO, MN 55356- <br /> ° (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3625 JACOBS MILL RD <br /> PIN : 32-118-23-24-0013 <br /> LEGAL DESC : JACOBS MILL <br /> : LOT 003 BLOCK 002 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 400.00 <br /> NOTE: GASLINE FOR POOL HEATER <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.20 <br /> MELGAARD SERVICES TOTAL 50.20 <br /> 6726 ESTES AVE. NW Payment(s) <br /> MAPLE LAKE, MN 55358- <br /> (763)286-9896 CHECK 2053 50.20 <br /> Minnesota State License#: mech-MB643538 <br /> OWIYER <br /> SCHMID, KURT&CAROL <br /> 2950 ISLAND VIEW DRIVE <br /> MOUND, MN 55364- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this pem�it 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[he 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 for due cause. <br /> - /2-/�- t� � / /�Z.r/ <br /> Applicant Per gnature Date [ss d By Signature Date <br />