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CITY OF ORONO PERMIT NO.: 2011-01274 <br /> . 2750 KELLEY PARKWAY <br /> . ORONO, MN 55356- �ATE �ssuE�: 10/19/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 930 COX FARM RD <br /> PIN : 27-118-23-33-0013 <br /> LEGAL DESC : SHADOWOOD FARM <br /> : LOT O10 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 5,150.00 <br /> NOTG: FPX MODEL 98500213 FP <br /> SEl�AND VENT -HOOK TO GAS LINE RUN BY O"1�11ERS <br /> APPLICANT MECHANICAL 64.38 <br /> WOODLAND STOVES& FIREPLACES STATE SURCHARGE MECH (VALUATION) 2.58 <br /> 2901 E. FRANKLIN AVE. <br /> MINNEAPOL[S, MN 5540:r MAIL-IN FEE 2.00 <br /> (612)338-6606 MISC FEE 0.00 <br /> TOTAL 68.96 <br /> OWNER <br /> I<ILLINGSTAD, MR. & MRS. <br /> 930 COX FARM RD <br /> LONG LAKE, MN 55356 <br /> AGREEMEIVT AND SWORN STATEMENT <br /> '1'hc��ork for��-hich this permit is issued shall bc performed according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> S[ate Building Code. This permit is for only the work described and does <br /> not grant pennission}or 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 l80 days of the date of issuance,or if construction is <br /> suspcnded for a period of 180 days at any time after work has commenced. <br /> The applican[is responsible for assuring all required inspections are <br /> requcsted in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> `�rj,�t'!�.-c-P �-r� � � l l <br /> Applicant Permitee Signature Date Issued By � ature ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO <br />