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' CITY OF ORONO <br /> * z013 - 01PJ25 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/O1/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2695 COUNTRYSIDE DR W <br /> PIN : 04-117-23-13-0005 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 005 BLOCK 003 <br /> PERMIT TYPE : MECHANICAL(> $500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCT[ON TYPE : GAS LINE ONLY <br /> VALUATION : $ I,550.00 <br /> NOTI�:: GnSLINE 1'OR POOL]IGn"I'I;R-2�0.000 F3TU <br /> APPLICANT MECHANICAL 50.00 <br /> METRO GAS INSTALLERS STATE SURCHARGE MECH(VALUATION) 0.78 <br /> 685 141ST LANE NW <br /> ANDOVER, MN 55304 TOTAL 50.78 <br /> (763)754-71 19 <br /> OWNER <br /> BICKETT, SCOTT& HOLLY <br /> 2695 COUNTRYSIDE DR W <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> 7�he work for which this permit is issued shall bc performed accordin�to <br /> the approved plans and specitications,applicable City approvals,and the <br /> State[3uilding Code. �Chis 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 N�ork <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 it�construction is <br /> suspended for a period of l80 days a[any time aYter work has commenced. <br /> �he applican[is responsible f assuring all requi nspections are <br /> requested in confor ce h th t te B 'Id' ode."Chis permit may be <br /> revoked at any.. or e ca e. � <br /> � �� �� � ��� �� ��� <br /> ,- � / <br /> A cant Permitee Si=nature Date ��� � � �� <br /> pp � Iss By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />