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CITY OF ORONO * z a 1 3 — 0 0 0 3 6 * <br /> 2750 KELLEY PARKWAY �aTE iSSUE�: OU15/2013 <br /> � ORONO, MN 55356- <br /> • (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4495 BAYSIDE RD <br /> PI IV : 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 : $ 1,600.00 <br /> NOTE: HEAT N GLO SL-750TR-IPI-3000BTU <br /> APPLICANT MECHANICAL 50.00 <br /> FIRESIDE HEARTH& HOME STATE SURCHARGE MECH (VALUATION) 0.80 <br /> 2700 FAIRVIEW AVE <br /> ROSEV[LLE, MN 55113 MAIL-IN FEE 2.00 <br /> (651)633-2561 TOTAL 52.80 <br /> Minnesota State License#: 20512060 <br /> OWIYER <br /> Katherine Taylor Homes, Inc. <br /> , <br /> AGREEMENT AIYD SWORN STATEMENT <br /> The work for which this permit is issued shall be performed accordin��to <br /> the approved plans and specifications,applicable City approvals,and thc <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 specitied 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 al any time after�vork has commenced. <br /> The applicant is responsible for assuring all required inspections arc <br /> requested in conformance with the State Building Code.'fhis pennit may be <br /> revoked at any time for du�'cause. <br /> �;YLtu..�-Q �'�, / / / / <br /> Applicant Permitee Signature Date Issued I3y gnature Datc <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER HAN DESCRIBED A VE. <br />