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' � � CITY OF ORONO * 2 0 1 3 - P1 0 1 3 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 02/27/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 560 DEBORAH DR <br /> PIIV : 31-118-23-23-0005 <br /> LEGAL DESC : MCCULLEY FARM <br /> : LOT 002 BLOCK 002 <br /> PERM�T TYPE : MECHANICAL(> $500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 3,500.00 <br /> NOTE: (1)HEAT N GLO GAS FnC"1'ORY FIREPLACE-MODEL-ESCAPG I30 <br /> APPLICANT MECHANICAL 50.00 <br /> FIRESIDE HEARTH & HOME STATE SURCHARGE MECH(VALUATION) 1.75 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE, MN 55113 MAIL-IN FEE 2.00 <br /> (651)633-2561 TOTAL 53.75 <br /> Minnesota State License#: 20512060 <br /> OWNER <br /> LUTH, W& MARCOUX <br /> 560 DEBORAH DR <br /> MAPLE PLAIN, MN 55359 <br /> AGREEMENT AND SWORN STATEMENT <br /> The 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 /> shall be compied with whe[her or not specitied herein.This permit will <br /> expire and become null and void if construc[ion authorized is not <br /> commenced within lA0 days of Ihe datc of issuance,or if consVuc[ion 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[ime for due cause. <br /> i i � �� � ,�7� �3 <br /> Applicant Permitee Signature Date Issu By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />