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, t <br /> CITY OF ORONO PERMIT NO.: 2010-00937 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 10/04/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2515 COUNTRYSIDE DR <br /> PIN : 04-117-23-11-0007 <br /> LEGAL DESC : COUNTRYSIDE MANOR <br /> : LOT 003 BLOCK 002 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 3,000.00 <br /> NOTIi: HF.AT N GLO GAS FnCTORY I'[RGPLACE 0 MODF;I,#8000 CLX <br /> APPLICANT MECHANICAL 50.00 <br /> FIRESIDE HEARTH& HOME STATE SURCHARGE MECH (VALUATION) 5.00 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE, MN 55113 MAIL-[N FEE 2.00 <br /> (651)633-2561 TOTAL 57.00 <br /> Minnesota State License#: 20512060 <br /> OWNER <br /> KAHLER, CHRIS& DELPHINE <br /> 2515 COUNTRYS[DE DR <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> 'l�he work for which this permit is issued shall be perfonned according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State E3uilding Code. This permit is for only the work described and does <br /> not grant pennission for additional or related work which requires separate <br /> permits. All provisions ot�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 a any time for due cause. <br /> /' .[.C.� �� �� ��� � ��' � �. ��l � l /�i <br /> Applicant Permitee Signature Date Issue y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />