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w <br /> ' <br /> CITY OF ORONO II I III I 11 I I !I III <br /> 2750 KELLEY PARKWAY * 2 0 1 7 - 0 0 7 0 <br /> DATE ISSUED: 06/26/2017 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 500 OLD CRYSTAL BAY RD S <br /> PIN : 04-117-23-42-0029 <br /> LEGAL DESC : CRYSTAL BAY RETREAT <br /> : LOT 1 BLOCK 1 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYI'E : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIX')'URE <br /> VALUATION : $ 500.00 <br /> NOTE: ALL TESTING REPORTS SHAD,BE ON SITE AT FINAL INSPECTION. <br /> REPLACE GAS DRYER <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.25 <br /> MN PLUMBING&APPLIANCE INC.. MAIL-IN FEE 2.00 <br /> 14105 RUTGERS STREET NE <br /> PRIOR LAKE,MN 55372- TOTAL 52.25 <br /> (952)469-8341 Payment(s) <br /> Minnesota State License#:cont-58455-4M CHECK 9054 52.25 <br /> OWNER <br /> i <br /> MERZ, BRIAN&KATIE <br /> 2412 BLACK LAKE RD <br /> SPRING PARK,MN 55384- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which thil permit is issued shall be ierformed according to <br /> the approved plans and pecifications,applicableity approvals,and the <br /> State Building Code. This permit is for only the 4ork described and does <br /> not grant permission for additional or related wor which requires separate <br /> permits. All provisions of laws and ordinances go'eming this type of work <br /> shall be compied with whether or not specified he$ein.This permit will <br /> expire and become null and void if construction agthorized is not <br /> commenced within 180 days of the date of issuan ,or if construction is <br /> suspended for a period of 180 days at any time aft r work has commenced. <br /> The applicant is responsible for assuring all requir d inspections are <br /> requested in conformance with the State Building ode.This permit may be <br /> revoked at any time for due cause. <br /> 614--"‘ej I kfiSOL) A4 . de ) /7 <br /> Applicant Permitee Signature Date Issued By Sfg4ature Date <br /> i <br />