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�- �� CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 4 — 0 0 1 1 9 * <br /> DATE ISSUED: 02/10/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 210 BIG ISLAND <br /> PIN . 23-117-23-23-0034 <br /> LEGAL DESC : MORSE ISLAND PARK <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(> $500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTTON TYPE : FIREPLACE- WOOD <br /> VAC.UATION : $ 5,300.00 <br /> NO�I�F.: WOOD BURNING I�'IRI:PLnCI;-QUnDRA F[RE-MODEL-ISLG ROYAL <br /> APPLICANT MECHAMCAL 66.25 <br /> STATE SURCHARGE MECH (VALUATION) 2.65 <br /> FIRESIDE HEARTH& HOME TOTAL 68.90 <br /> 2700 FAIRVIEW AVE Payment(s) <br /> ROSEVILLE, MN 551 13 <br /> (651)633-2561 CHECK 2003532 68.90 <br /> Minnesota State License �: mech-20512060 <br /> OWNER <br /> CHAMPLIN,JUDSON K <br /> 2643 THOROUGHBRED LN <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> I�he 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. 'Phis permit is for only the work described and does <br /> not grant permission for additional or related work which requires separatc <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specified hercin.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced�vithin 180 days of the date ot�issuance,or if construction is <br /> suspended for a period of 180 days at any time atter work has commenced. <br /> I�he applicant is responsible for assuring all rcquired inspections are <br /> requested in conformance��ith the State E3uilding Code."This permit may be <br /> revoked at any time for due cause. <br /> i� o� � oll `� Z, � / �'� / <br /> Applicant Permitee Signature Date, Issued ,�Signature Dale <br />