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CITY OF ORONO �, '� I�' � ��� � I!� <br /> * 20 1 4 - 00689 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/02/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 840 OLD CRYSTAL BAY RD S <br /> PIN : 09-117-23-12-0002 <br /> LEGAL DESC : UNPLATTED 09 117 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 3,200.00 <br /> NOTE: GASLINE FOR POOL HEATER AND FIREPLACE <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 1.60 <br /> METRO GAS INSTALLERS TOTAL 51.60 <br /> 685 141ST LANE NW <br /> Payment(s) <br /> ANDOVER, MN 55304 <br /> (763)754-7119 CHECK 14790 51.60 <br /> Minnesota State License#:mech-MB003162 <br /> OWNER <br /> HEIZMAN-WILLIAMS,JAMES WILLIMAS&HEIDI <br /> 840 OLD CRYSTAL BAY RD S <br /> WAYZATA, MN 55391- <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 /> revoked at any t. e r due cause. <br /> 7,..g____1/ / / / di- <br /> / 7 ,,:, ,,igt/ <br /> App icant Permitee ignature Date Issu.� :y Signature Date <br />