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� � CITY OF ORONO * z p� 1 5 - 0 1 3 7 8 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/27/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 4565 BAYSIDE RD <br /> PIN : 06-117-23-21-0010 <br /> LEGAL DESC : BAYSIDE BERRY FARM <br /> : LOT 2 BLOCK 1 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> COI�ISTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 8,089.38 <br /> NOTE: HEAT-N-GLO GAS FIREPLACE <br /> APPLICANT MECHANICAL 101.12 <br /> STATE SURCHARGE MECH(VALUATION) 4.04 <br /> GLOWING HEARTH AND HOME MAIL-IN FEE 2.00 <br /> 100 ELDORADO DRIVE <br /> JORDAN, MN 55352 TOTAL 107.16 <br /> (952)495-2927 Payment(s) <br /> CHECK 21947 107.16 <br /> OWNER <br /> DOUBECK,TIM&MARY <br /> 4565 BAYSIDE RD <br /> MAPLE PLAIN, MN 55359- <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 goveming this type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become n�ll 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 afrer 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 /> � � -� �� /� i�,1 i �S <br /> Applic nt Permitee Signature Date Issue y Signature Date <br />