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. CITY OF ORONO PERM[T NO.: 2009-00887 <br /> ' 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE [ssuEn: 12/10/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1991 FAGERNESS POINT RD <br /> P[N : 18-117-23-41-0001 <br /> LEGAL DESC : FAGERNESS <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHAN[CAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 1,700.00 <br /> NO"I'E: GAS LONG HEAT N GLO STF018 <br /> APPLICANT MECHAN[CAL 50.00 <br /> FIRES[DE HEARTH &HOME STATE SURCHARGE MECH (VALUATION) 0.85 <br /> 2700 FA[RVIEW AVE <br /> ROSEVILLE, MN 55113 MISC FEE 0.00 <br /> (651)633-2561 MAIL-IN FEE 1.65 <br /> Minnesota State License#: 20512060 TOTAL 52.50 <br /> OWNER <br /> MILLIREN,GUY& SALLY <br /> 1991 FAGERNESS PT RD <br /> WAYZATA, MN 55391 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this pennit is issucd shall be perfonncd according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This permit is for only the work dcscribed and does <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions oY laws and ordinances governing this type of work <br /> shall be compied with whe[he�or not specitied herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within l80 days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time atter 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 /> ��'yc.Qt-�-Q (n-- / / �i�J�_, l l <br /> Applicant Permitee Signature Date Issued E3y S� ature atc <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO . <br />