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CITY OF ORONO * 2 0 1 z - 0 0 1 4 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 02/22/2012 <br /> „ ORONO, MN 55356- <br /> � (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 475 FERNDALE RD N <br /> PIN : 36-118-23-14-OO12 <br /> LEGAL DESC : HAUSER LAUER WCC ADDN <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 2,000.00 <br /> NOTt;: 1 HEA"I'N'GLO GAS PIREPLACE, MODEL NO.G024SP-NG <br /> APPLICANT MECHANICAL 50.00 <br /> FIRESIDE HEARTH & HOME STATE SURCHARGE MECH (VALUATION) 1.00 <br /> 2700 FAIRVIEW AVE TOTAL 51.00 <br /> ROSEVILLE, MN 55113 <br /> (65l)633-2561 <br /> Minnesota State License#: 20512060 <br /> OWNER <br /> HOESLEY, JOE& SHELLY <br /> 475 FERNDALE RD N <br /> WAYZATA, MN 55391- <br /> ACREEMENT AND SWORN STATEMENT <br /> I'he work for which this permit is issued shall be performed according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> State E3uilding Code. This permit is for only the work described and does <br /> not grant permission for additional or related work which requires separatc <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become niill and void if construction authorized is not <br /> commenced within I 80 days of the date of issuance,or if construction is <br /> suspended lor a period of 180 days at any time aRer work has conunenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with the State Building Code.This permit may bc <br /> revokzd at any time 1or due cause. ,� <br /> �� '� ��� ���� �,�� ��,/�. � L �_ (`��)�{�1(,f i i %l,l�.J � �.�%� -� _. <br /> �C <br /> Applicant Permitee Signature Date Issued E3y Signature Date <br /> SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />