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� <br /> � - CITY OF ORONO * z 0 1 2 - 0 1 1 4 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 1U08/2012 <br /> � ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1755 CONCORDIA ST <br /> PIN : 17-117-23-22-0018 <br /> LEGAL DESC : COFFEES ADDN TO SHADY WOOD LAK <br /> : LOT 012 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(> $500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 3,000.00 <br /> NOTE: I IEA"I II,ATOR ND130C GAS FIREPLACE <br /> APPLICANT MECHAN ICAL 50.00 <br /> FIRESIDE HEARTH & HOME STATE SURCHARGE MECH (VALUATION) 1.50 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE, MN 55113 MA[L-IN FEE 2.00 <br /> (651)633-2561 TOTAL 53.50 <br /> Minnesota State License#: 20512060 <br /> OWNER <br /> KOHRS, DOUGLAS <br /> (755 CONCORDIA ST <br /> WAYZATA, MN 55391 <br /> AGREEMENT AND SWORN STATEMENT <br /> ��he work fbr which this permit is issued shall bc performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State[3uilding 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 are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause� <br /> \l� � / / / / <br /> Applicant Permitee Signature Dale <br /> Issued Bv S� ature D te <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A VE. <br />