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� _. <br /> � CITY OF ORONO * 2 0 1 8 - 0 0 0 5 7 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OU18/2018 <br /> ORONO,MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2695 SHADYWOOD RD <br /> PIIv : 21-117-23-24-0056 <br /> LEGAL DESC : CHAPMAN ADDN <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 8,693.00 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> (1)HHT ESCAPE-I35 INSERT W/GAS LINE <br /> APPLICANT MECHANICAL 108.66 <br /> STATE SURCHARGE MECH(VALUATION) 4.35 <br /> FIRESIDE HEARTH&HOME MAIL-IN FEE 2.00 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE,MN 55113 TOTAL 115.01 <br /> (651)633-2561 Payment(s) <br /> Minnesota State License#:mech-20512060 CREDIT CARD 4616 115.01 <br /> OWNER <br /> PAULSON,STEPHEN&BOTHAINA <br /> 2695 SHADYWOOD RD <br /> EXCELSIOR,MN 55331- <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 dces <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 aRer work has commenced. <br /> The applicant is responsible for assuring all required inspections aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> �� ! ' ' I'C'� � l �✓ l I V <br /> �G�,I � <br /> Applicant Permitee Signature Date Issue y Signature Date <br />