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, � <br /> CITY OF ORONO * 2 0 1 6 - PJ 0 2 1 S * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 03/04/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2565 DUNWOODY AVE <br /> pl� : 20-117-23-21-0031 <br /> LEGAL DESC : TOWNSITE OF LANGDON PARK <br /> : LOT 000 BLOCK 008 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 3,500.00 <br /> NOTG: (2) PETERSON GAS LOG SETS <br /> APPL[CANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 1.75 <br /> TWIN CITY FIREPLACE STONE CO INC MAIL-IN FEE 2.00 <br /> 6521 CEC[L[A CIR <br /> EDINA,MN 55439- TOTAL 53J5 <br /> (952)941-2685 Payment(s) <br /> Minnesota State License#:mech-MB682977 CREDIT CARD 0657 53.75 <br /> OWNER <br /> RUCINSKO, MICHAEL&MARY <br /> 2565 DUNWOODY AVE <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 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 goveming 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 I80 days of the date of issuance,or if consuuction 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 /> ( f o �c �v � , ;�� <br /> Applicant Permitee Signature Date Issued By 'gnature Date <br />