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CITY OF ORONO * 2 0 1 z - 0 0 1 9 2 * <br /> ' 2750 KELLEY PARKWAY DATE ISSUED: 03/14/2012 <br /> ` ORONO,MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2900 DEER RUN TR <br /> PIN : 04-117-23-24-0013 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 008 BLOCK 004 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTI01�1 TYPE : FIREPLACE-GAS <br /> VALUATION : $ 3,200.00 <br /> NOTE: HEAT N GLO PALOMA-MOD <br /> APPLICANT MECHANICAL 50.00 <br /> FIRESIDE HEARTH&HOME STATE SURCHARGE MECH(VALUATION) 1.60 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE,MN 55113 MAIL-IN FEE 2.00 <br /> (651)633-2561 MISC FEE 0.00 � <br /> Minnesota State License#:20512060 TOTAL 53.60 <br /> OWNER <br /> KACZKE,ROBERT&JILL <br /> 2900 DEER RUN TR <br /> LONG LAKE,MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be perfortned according to <br /> the approved plans and specifications,appiicable 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 goveming 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 time for due cause. <br /> �-yK.�-� �- l � ��ryt,.�� / / <br /> Applicant Permitee Signature Date Issued By S' ature ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB <br />