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� CITY OF ORONO * 2 0 1 2 - P1 0 7 4 Z * <br /> 2750 KELLEY PARKWAY DATE 1SSUED: 08/OU2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1 14 CHEVY CHASE DR <br /> PIN : 36-118-23-41-0035 <br /> LEGAL DESC : HILL O'WAY MANOR <br /> : LOT 001 BLOCK 002 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 3,000.00 <br /> NOTE: I IEAT N GLO ESCAPE I30 C GAS FP <br /> APPLICANT MECHANICAL 50.00 <br /> FIRESIDE HEARTH& HOME STATE SURCHARGE MECH(VALUATION) 1.50 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE, MN 55113 MAIL-IN FEE 2.00 <br /> (651)633-2561 TOTAL 53.50 <br /> Minnesota State License#: 20512060 <br /> OWNER <br /> MCLEAN, CHRISTOPHER& ELIZABETH <br /> 114 CHEVY CHASE DR <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMEIVT <br /> The work for which this pennit is issued shall be performed according to <br /> [he approved plans and specitications,applicable City approvals,and the <br /> State Building Code. This permit is for only the work described and does <br /> no[gran[permission for additional or related work which requires separate <br /> pennits. 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[he 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 /> `�-c-�-P �- l l ��Yvl�-� l l <br /> Applicant Permitee Signature Date Issued By ignature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E. <br />