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� � � CITY OF ORONO <br /> * 2 0 1 3 - 0 Pl 2 5 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 04/17/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2765 SHADYWOOD RD <br /> PIN : 21-117-23-24-0060 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0415 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHAMCAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 3,000.00 <br /> NOTE: GAS FAC"IORY F[REPLACE-HEATILA"I'OR-MODGL NO.NDI35-C <br /> APPLICAI�IT MECHANICAL 50.00 <br /> FIRESIDE HEARTH& HOME STATE SURCHARGE MECH(VALUATION) 1.50 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE, MN 55113 MAIL-IN FEE 2.00 <br /> (651)633-2561 TOTAL 53.50 <br /> Minnesota State License#: 20512060 <br /> OWNER <br /> RANDGAARD, THOMAS <br /> 1730 KENWOOD PKWY <br /> MINNEAPOLIS, MN 55405- <br /> � <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specitications,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 governing d�is 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 I3uilding Code.This permit may be <br /> revoked at any time for due cause. ,* � <br /> ��ii {:-�__ __ � 4� � 7 � /� � <br /> -� ,,� <br /> �� 7_i;, , �j /� l�' <br /> Applicant Permitee Signature Date Issued� y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />