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, CITY OF ORONO * z 0 1 6 - 0 0 6 5 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/06/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 787 BOULDER DR <br /> PIN : 33-118-23-11-0132 <br /> LEGAL DESC : STONEBAY <br /> : LOT 7&8 BLOCK 1 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 3,205.00 <br /> NOTE: (I)GAS FIREPLACE IN REC ROOM <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 1.60 <br /> FIRESIDE HEARTH& HOME MAIL-IN FEE 2.00 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE, MN 55113 TOTAL 53.60 <br /> (651)633-2561 Payment(s) <br /> Minnesota State License#: mech-20512060 CREDIT CARD 4608 53.60 <br /> OWNER <br /> PIERCE FAM TRUST, MARY SUE <br /> 5491 ANDERSON ESTATES RD <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 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 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 /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> � �/ 1� -� (�' CP l l(� <br /> Applicant Permitee Signature Date Issued B ignature Date <br />