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�' CITY OF ORONO <br /> , 2750 KELLEY PARKWAY * 2 0 1 6 - 0 1 4 1 1 * <br /> DATE ISSUED: 1 U07/2016 <br /> ' ORONO,MN 55356- <br /> (952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 265 LEAF ST <br /> PIN : OS-117-23-14-0002 <br /> LEGAL DESC : AUDITOR'S SUBD.NO.203 <br /> : LOT 009 BLOCK 000 <br /> PERMTT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $400.00 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> REPLACE GAS LINE TO FUIRNACE APPROXATLY 30 FEET <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.20 <br /> CENTERPOINT ENERGY MAIL-IN FEE 2.00 <br /> 6161 GOLDEN VALLEY RD TOTAL 52.20 <br /> BUILDING A <br /> GOLDEN VALLEY,MN 55422- Payment(s) <br /> (763)512-2765 CHECK 20654 52.20 <br /> Minnesota State License#:mech-MB003503 <br /> OWNER <br /> STOCKTON,HARLAN <br /> 265 LEAF ST <br /> LONG LAKE,MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be perfom►ed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This perntit is for only the work described and dces <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.1'his permit may be <br /> revoked at any time for due cause. <br /> � `-�--� -�� C t � �� <br /> Applicant Perm tee Signature Date Issued By Signature Date <br />