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� CITYOFORONO * z0 14 - 00599 * <br /> � 2750 KELLEY PARKWAY ppTE tsSUED: 06/13/2014 <br /> � ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 105 CREEK RIDGE PASS <br /> PIIY : 03-117-23-12-0012 <br /> LEGAL DESC : CREEKS[DE [N ORONO <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(> $500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE- GAS <br /> VALUATION : $ 8,200.00 <br /> �vo��F: ? �icn�r�v c�o c�As F�ai�.Y�nci:s <br /> APPLICANT MECHANICAL 102.50 <br /> STATE SURCHARGE MECH (VALUATION) 4.10 <br /> FIRESIDE HEARTH & HOME MAIL-IN FEE 2.00 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE, MN 55113 TOTAL 108.60 <br /> (651)633-2561 Payment(s) <br /> Minnesota State License#: mech-20512060 CHECK 2004500 108.60 <br /> OWNER <br /> ROBIN, JOHN & CYNTHIA <br /> 5925 FIELDSTONE PLACE <br /> INDEPENDENCE, MN 55359- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed accordine to <br /> Ihe approved plans and specifications,applicable City approvals,and thc <br /> State Building Code. This pemiit is for only the work described and does <br /> not grant pern�ission for additional or related work which requires separatc <br /> permits All provisions of laws and ordinances goveming this type of work <br /> shall be compied with whether or not specitied herein.This permit N�ill <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 davs ot[he date of issuance,or if construction is <br /> suspended for a period of 180 days al 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."i'his permit may be <br /> revoked at any time for due cause. <br /> t <br /> !-F'•� O / / <br /> Applicant Permrte�ignature Dale Issued 13v S' ture Date <br />