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� � <br /> CITY OF ORONO * 2 0 1 2 - 0 1 2 2 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 12/05/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4355 CH(PPEWA LA <br /> PIN : 31-118-23-42-0020 <br /> LEGAL DESC : N/A <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(> $500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 425.00 <br /> NOTG: GAS LING 1'O YOOL 1IEATER <br /> HEATING SYSTGM SUPPLIGD BY POOL CONTRACTOR <br /> APPLICANT MECHANICAL 50.00 <br /> MELGAARD SERVICES STATE SURCHARGE MECH (VALUATION) 0.21 <br /> 6726 ESTES AVE. NW <br /> MAPLE LAKE, MN 55358- TOTAL 5021 <br /> (763)286-9896 <br /> OWNER <br /> YOUNG,JOHN& LYNN <br /> 4355 CHIPPEWA LA <br /> MAPLE PLA1N, MN 55359- <br /> AGREEMENT AND SWORN STATEMENT <br /> The evork for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State[3uilding 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 /> suspcnded for a period of 180 days a[any time af[er work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in confonnance with the State Building Code.This permit may be <br /> rev � at any time for due cause. <br /> /Z / S / /� / / <br /> App ermitee Signature Date Issued By S� aturc Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E. <br />