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1 <br /> CITY OF ORONO * z 0 1 z - a 1 z 6 8 * <br /> ' 2750 KELLEY PARKWAY pATE ISSUED: 12/21/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4495 BAYSIDE RD <br /> PIN : 06-117-23-21-0004 <br /> LEGAL DESC : UNPLATTED 06 1 17 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 4,300.00 <br /> NO��I?: 2 I IF,AT N GLO X2SL750"CR-IPI-30000 B"CU <br /> APPLICANT <br /> MECHANICAL 53.75 <br /> FIRESIDE HEARTH & HOME STATE SURCHARGE MECH (VALUAT[ON) 2.15 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE, MN 55113 MAIL-IN FEE 2.00 <br /> (651)633-2561 TOTAL 57.90 <br /> Minnesota State License#: 20512060 <br /> OWNER <br /> Katherine Taylor Homes, Inc. <br /> AGREEMENT AND SWORIV STATEMENT <br /> The�vork ti�r which this permit is issucd shall be performed according to <br /> the approvcd plans and specifications,applicable City approvals,and the <br /> State Building Code. This permit is for only the work described and docs <br /> not grant permission for additional or rclated 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 permi[will <br /> cxpire 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 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 causS. <br /> ���Z�� �� i i i i <br /> Applicant Permitee Signature � Date [ssued E3y Si ature —➢�ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A VE. <br />