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� , CITY OF ORONO * z 0 1 7 - 0 0 6 7 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/2U2017 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2040 SPATES AVE <br /> PIN : 10-117-23-31-0090 <br /> LEGAL DESC : ORA PARK ON LAKE MTKA <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 600.00 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> GASLINE FOR FUTURE F(RE TABLE <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 030 <br /> PLUMBING RESTORATION&SERVICES LLC MAIL-IN FEE 2.00 <br /> 889 PIERCE BUTLER ROUTE TOTAL 52.30 <br /> UNIT F <br /> ST PAUL, MN 55104- Payment(s) <br /> (651)253-1083 CREDIT CARD 5723 5230 <br /> Minnesota State License#:mech-MB005526 <br /> OWIYER <br /> DAMMEN, SUSAN <br /> 2040 SPATES AVE <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 afrer 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 /> � �U /O / � <br /> Applicant Permitee Signature Date [ssued By ' ature Date <br />