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, • <br /> CITY OF ORONO PERMIT NO.: 2009-00506 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE ISSUEn: 08/2U2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1212 BRIAR ST <br /> PIN : 10-117-23-31-0075 <br /> LEGAL DESC : MAXWELLS ADDN CRYSTAL BAY LAKE <br /> : LOT 000 BLOCK 002 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 2,500.00 <br /> NOTE: KOLY HEAT GAS FIREPLACE-MODEL NO.91 1 <br /> APPLICANT MECHAN[CAL 50.00 <br /> PRACTICAL SYSTEMS STATE SURCHARGE MECH (VALUATION) 1.25 <br /> 4342 B SHADY OAK RD TOTAL 51.25 <br /> HOPKINS, MN 55343 <br /> (952)933-1868 <br /> OWNER <br /> KIEMEN, R&J <br /> 1212 BRIAR ST <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shali 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 rela[ed 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 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 are <br /> requested in confor ance with the State Building Code.This permit may be <br /> revo d at any tim r due�ause.� ' � <br /> � � � � �` i Zi i <br /> �S' i o2/i D <br /> A icant Per tee ' nature Date � sue By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />