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;� CITY OF ORONO * 2 P1 1 4 - 0 0 0 1 5 * <br /> �, 2750 KELLEY PARKWAY DATE ISSUED: 01/07/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952 249-4616 <br /> ADDRESS : 2990 SUSSEX RD <br /> PIN : 04-117-23-31-0020 <br /> LEGAL DESC : FOX BEND <br /> : LOT 3 BLOCK 4 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 12,900.00 <br /> NOTE: 2 GAS FP <br /> MONTIGO R620N <br /> KOZY HEAT SCA-42-IPI-S <br /> APPLICANT MECHANICAL 161.25 <br /> STATE SURCHARGE MECH(VALUATION) 6.45 <br /> GLOWING HEARTH AND HOME MAIL-IN FEE 2.00 <br /> 100 ELDORADO DRIVE <br /> JORDAN,MN 55352 TOTAL 169.70 <br /> (952)495-2927 Payment(s) <br /> CHECK 18234 169.70 <br /> OWNER <br /> KELLY,JUSTIN& SUSAN <br /> 2990 SUSSEX RD <br /> LONG LAKE, MN 55356- <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 does <br /> not grant permission for additional or related work which requires sepazate <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 /> �/)•j. ,�l�.� �� / / <br /> Applicant Permitee Signature Date Issued By gnature Date <br />