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� <br /> �r CITY OF ORONO PERMIT NO.: 2011-01467 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 5535C- DATE ISSUED: 1U22/2011 <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 : $ 4,000.00 <br /> NOTE: GAS FACTORY FIR�PLACE-PETGRSON-GAS LOG SL"1' <br /> APPLICANT MECHANICAL 50.00 <br /> GLOWING HEARTH AND HOME STATE SURCHARGE MECH(VALUATION) 2.00 <br /> 100 ELDORADO DRIVE <br /> JORDAN,MN 55352 MAIL-IN FEE 2.00 <br /> (952)495-2927 TOTAL 54.00 <br /> PAID WITH CC# 9799 <br /> OWNER <br /> KILL[NGSTAD, MR.& MRS. <br /> 930 COX FARM RD <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORN STATEMENT <br /> I'he 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 only the work described and does <br /> not grant permission for additional or rela[ed work which requires separate <br /> permits. All provisions of laws and ordinances governing this type of�work <br /> shali be compied with whether or not specified herein.7'his permit will <br /> expire and become null and void if construc[ion authorized is no[ <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of l80 days at any time atter work has commenced. <br /> The applicant is responsible for assuring all required inspec[ions are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any txne for du�e. _ <br /> � �li ��� � � �� �� <br /> Applicant Permitee Signature Date � Issu By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />