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' � CITY OF ORONO * 2 0 1 3 - 0 0 3 2 2 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OS/07/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2515 KELLY AVE <br /> PIN : 20-117-23-12-0038 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1428 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 1,005.00 <br /> NOTE: GASLINE FOR OUTDOOR GRILL <br /> APPLICANT MECHANICAL 50.00 <br /> AC TOMPKINS PLBG& HEATING STATE SURCHARGE MECH(VALUATION) 0.50 <br /> 16445 221ST AVE NW <br /> ELK RIVER, MN 55330- TOTAL 50.50 <br /> (952)420-9028 <br /> OWNER <br /> HARDTEN, DAVID&CHRISTINE <br /> 2515 KELLY AVE <br /> EXCELSIOR, MN 55331- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which[his 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 nuli and void if construc[ion 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 y t cause. � <br /> � , �� , i3 � � <br /> Applicant Permitee Signature Date Issu By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />