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CITY OF ORONO * 2 0 1 3 — 0 1 1 2 3 * <br /> � ' 2750 KELLEY PARKWAY DATE ISSUED: 10/23/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2696 CAROLINE AVE <br /> PIN : 20-117-23-24-0034 <br /> LEGAL DESC : WESSELS SUBD OF SPRING PARK LO <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(> $500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : F[REPLACE-GAS <br /> VALUAT[ON : $ 4,000.00 <br /> NOTI:: HL,A"I'N GLO F,SCAPE 135 <br /> APPLICANT MECHANICAL 50.00 <br /> FIRESIDE HEARTH& HOME STATE SURCHARGE MECH(VALUATION) 2.00 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE, MN 55113 MAIL-IN FEE 2.00 <br /> (651)633-2561 TOTAL 54.00 <br /> Minnesota State License#: 20512060 <br /> OWNER <br /> MILLER,JILL <br /> 2696 CAROLINE AVE <br /> WAYZATA,MN 55391- <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 specitied herein.This permit will <br /> expire and become null and void if cons[ruction authorized is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of 1 AO days at any time after 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 Yor due cause. <br /> `�'tiCQ.c.Q �'l i l G�YLt�L�, l l <br /> Applicant Permitee Signature Date Issued By Si ature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED BOVE. <br />