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CITY OF ORONO PERMIT NO.: 2009-00797 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 11/09/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS 2575 THOROUGHBRED LA <br /> PIN 04-117-23-11-0021 <br /> LEGAL DESC OLD CRYSTAL BAY ROAD 2ND ADDN <br /> LOT 004 BLOCK 002 <br /> PERMIT TYPE MECHANICAL(>$500) <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE FIREPLACE-GAS <br /> VALUATION $ 2,753.00 <br /> NOTE: GAS FACTORY FIREPLACE-BRAND NAME: KOZY HEAT,MODEL NO: TH30 <br /> APPLICANT MECHANICAL 50.00 <br /> STATEWIDE GAS SERVICES STATE SURCHARGE MECH(VALUATION) 1.38 <br /> 201 WEST MAIN <br /> MN 55387- <br /> TOTAL 51.38 <br /> (952)447-7185 <br /> OWNER <br /> SAPLETAL, STEVEN&STACY <br /> 2575 THOROUGHBRED LA <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 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 after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in co trance 'ldin Code.This permit may be <br /> revoke e for <br /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />