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, CITY OF ORONO * 2 0 1 4 - 0 0 2 2 5 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 03/20/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4055 ELM ST <br /> P[N : 06-117-23-41-0106 <br /> LEGAL DESC : MINNETONKA SUMMIT PARK <br /> : LOT 000 BLOCK 009 <br /> PERMIT TYPE : MECHANICAL(> $500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 3,000.00 <br /> NO"CI;: GAS FACTORY PIREPLACE- MODF.L SLR-C <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH (VALUATION) 1.50 <br /> FIRESIDE HEARTH & HOME <br /> 2700 FAIRVIEW AVE MAIL-IN FEE 2.00 <br /> ROSEVILLE, MN 551 13 TOTAL 53.50 <br /> (651)633-2561 Payment(s) <br /> Minnesota State License#: mech-20512060 CHECK 2004010 53.50 <br /> OWNER <br /> FRITZ, MATT <br /> 9125 LOUISIANA AVE N <br /> BROOKLYN PARK, MN 55443- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which d�is permit is issued shall bc performed according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> State Building Code. 1'his permit is for only the work described and docs <br /> not grant perniission 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 specitied herein.This permit will <br /> expire and become null and void if construction auUiorized is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of I SO days at any time alter work has commenced. <br /> The applicant is responsible for assuring all requircd inspections are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> ;;%i� G ___ <br /> 3- � � --�y �- ,� � <br /> Applicant Permitee Signature Date Issue y Signature Date <br />