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' CITY OF ORONO <br /> ` 2750 KELLEY PARKWAY * Z 0 1 5 - 0 1 2 1 4 * <br /> DATE ISS[TED: 09/2U2015 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3928 CHERRY AVE <br /> PIN : 08-117-23-33-0018 <br /> LEGAL DESC : CRYSTAL BAY VIEW <br /> : LOT 000 BLOCK 004 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 4,340.00 <br /> NOTE: BOTH GAS&WOOD FIREPLACES BEING INSTALLED <br /> APPLICANT MECHANICAL 54.25 <br /> STATE SURCHARGE MECH(VALUATION) 2.17 <br /> GLOWING HEARTH AND HOME MAIL-IN FEE 2.00 <br /> 100 ELDORADO DRIVE <br /> JORDAN, MN 55352 TOTAL 58.42 <br /> (952)495-2927 Payment(s) <br /> CHECK 21655 58.42 <br /> OWNER <br /> GUSTAFSON,J&A <br /> 3928 CHERRY ST <br /> MOLJND,MN 55364- <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 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 after work has commenced. <br /> The applicant is responsible for assuring all required inspections aze <br /> requested in conformance with the State Building Code.This permit may be (��� <br /> revoked at any time for due cause. � <br /> c <br /> � <br /> �� � �.�-� _� �2� � ���� ����/ /�S <br /> Applicant Perrnitee Signature Date Issued By Signature Date <br />