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� �' CITY OF ORONO * z 0 1 5 - 0 1 2 9 8 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/07/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 965 EDGEWOOD HILLS RD <br /> PIN : 02-117-23-14-0001 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1098 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHAN[CAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 3,220.00 <br /> NOTE: ADDITIONAL GAS FACTORY FIREPLACE(HEAT N'GLO) <br /> APPLICANT MECHAN[CAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 1.61 <br /> FIRES[DE HEARTH& HOME MAIL-IN FEE 2.00 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE, MN 55113 TOTAL 53.61 <br /> (651)633-2561 Payment(s) <br /> Minnesota State License#: mech-20512060 CREDIT CARD 4608 53.61 <br /> OWNER <br /> BJORK, ROBERT&BETH <br /> 965 EDGEWOOD HILLS RD <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMEIYT <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 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. �l�� � <br /> ' � � � ` L' `7 <br /> � ��� � � �- ��� -� �c��_ � d-� ._; ��-�� � � � rs <br /> Applicant Permitee Signature Date Issued By Signature Date <br />