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CITY OF ORONO *� 4 - 0 0 9 6 6 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 08/27/2014 <br /> ' ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2630 COUNTRYSIDE DR W <br /> PIN : 04-117-23-12-0015 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 007 BLOCK 002 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 4,025.00 <br /> NOTE: HEAT N-GLO-CDFL4136 <br /> APPLICANT MECHANICAL 50.31 <br /> STATE SURCHARGE MECH (VALUATION) 2.01 <br /> FIRESIDE HEARTH& HOME MAIL-IN FEE 2.00 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE,MN 55113 TOTAL 54.32 <br /> (651)633-2561 Payment(s) <br /> Minnesota State License#: mech-20512060 CREDIT CARD 4608 54.32 <br /> OWNER <br /> URNESS, TODD& KATHERINE <br /> 2630 COUNTRYSIDE DR W <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed accordine to <br /> the approved�lans and specifications,applicable City approvals,and the <br /> S�ate Building 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 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 afrer 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 /> f��� �-�-J �jv�Q O � � <br /> � � <br /> Applicant Permitee Signature Date Issued By Signature Date <br />