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CITYOFORONO * 20 15 - 00437 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 04/16/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3460 BIRCH LA <br /> PIN : 08-117-23-43-0027 <br /> LEGAL DESC : LYDIARDS PARK LAKE MTKA <br /> : LOT 019 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 1,949.00 <br /> NOTE: (1)HEATILATOR GAS FIREPLACE <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.97 <br /> GLOWING HEARTH AND HOME MAIL-IN FEE 2.00 <br /> 100 ELDORADO DRIVE <br /> JORDAN,MN 55352 TOTAL 52.97 <br /> (952)495-2927 Payment(s) <br /> CHECK 20792 52.97 <br /> OWNER <br /> LISLE, STEVE&ANGELA <br /> 3460 BIRCH LA <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 onty 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 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 are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> �:- �� � ��, % <br /> Applicant Permitee S' ture Date Issue By Signature Date <br />