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! . . � <br /> CITY OF ORONO * 2 0 1 6 - 0 1 2 9 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/12/2016 <br /> - ORONO,MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2166 SHADYWOOD RD <br /> PIN : 17-117-23-42-0011 <br /> LEGAL DESC : WILEYS PARK LAKE MTKA <br /> : LOT 000 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 4,000.00 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> (2)GAS HEAT-N-GLO FIREPLACES-MODEL#SL-3X <br /> GASLINE DONE BY OTHERS <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 2.00 <br /> GLOWING HEARTH AND HOME MAIL-IN FEE 2.00 <br /> 100 ELDORADO DRIVE <br /> JORDAN,MN 55352 TOTAL 54.00 <br /> (952)495-2927 Payment(s) <br /> CHECK 23776 54.00 <br /> OWNER <br /> LACROIX,STEPHEN&SUSAN <br /> 2166 SHADYWOOD RD <br /> WAYZATA,MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be perFormed acwrding 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 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 1 SO days at any time aRer work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in wnfortnance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> . <br /> •e /O � / "o� � (o <br /> Applicant Permitee Signature Date Issued B ignature Date <br />