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, CITY OF ORONO PERMIT NO.: 2011-01513 <br /> . 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 12/05/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 141 CHEVY CHASE DR <br /> P 1 N : 3 6-118-23-41-0026 <br /> LEGAL DESC : HILL O'WAY MANOR <br /> : LOT 021 BLOCK 001 <br /> PERMIT TYPE : MECHAMCAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 8,000.00 <br /> NOTE: 1 I IBAT N GLOR CORONA 36 <br /> 1 HGAT N GLOO ESCAPE 130 FB <br /> APPLICANT MECHANICAL 100.00 <br /> FIRESIDE HEARTH& HOME STATE SURCHARGE MECH(VALUATION) 4.00 <br /> 2700 FAIRV[EW AVE <br /> ROSEVILLE, MN 551 13 MAIL-IN FEE 2.00 <br /> (651)633-256] MISC FEE 0.00 <br /> Minnesota State License#: 20512060 TOTAL 106.00 <br /> OWIVER <br /> REMARK, ROGER& MEGAN <br /> 141 CHEVY CHASE DR <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> "1'he work for which this permit is issued shall be performed according to <br /> the approved plans and speciYications,applicable City approvals,and the <br /> State Building Code. This permit is for only the work described and does <br /> not grant pemtission 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 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 permi[may be <br /> revoked at any time for due cause. <br /> ��tit�c..� �- / / / / <br /> Applicant Permitee Signature Date Issued By S' ature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A E. <br />