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� CITY OF ORONO PERMIT NO.: 2010-00307 <br /> , 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE IssUEn: OS/OS/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3205 CRYSTAL BAY RD <br /> PIN : 17-117-23-41-0011 <br /> LEGAL DESC : TOWNSITE OF LANGDON PARK <br /> : LOT 001 BLOCK 002 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 2,700.00 <br /> NOTE: 1 GAS FACTORY F[REPLACE HEAT N GLO SOI 10 24 <br /> APPLICANT MECHANICAL 50.00 <br /> FIRESIDE HEARTH & HOME STATE SURCHARGE MECH (VALUATION) 1.35 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE,MN 55113 MAIL-IN FEE 2.00 <br /> (651)633-2561 MISC FEE 0.00 <br /> Minnesota State License#: 20512060 TOTAL 53.35 <br /> OWNER <br /> ANDERSON, RICHARD <br /> 3205 CRYSTAL BAY RD <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specifica[ions,applicable City approvals,and the <br /> State Building Code. This permit is for only the work described and docs <br /> not grant permission for additional or relatcd 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 specitied 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 /> reques[ed in conformance with the S[ate Building Code.This permit may be <br /> revoked at any time for due cau9e. <br /> ��'�,'(Q� �K� / / / / <br /> Applicant Permitee Signature Date Issued By nature ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCR[BED ABO . <br />