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CITY OF ORONO * 2 0 1 3 - 0 1 1 5 7 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/30/2013 <br /> r ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 519 FERNDALE RD N <br /> PIN : 36-118-23-14-0008 <br /> LEGAL DESC : UNPLATTED 36 118 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(> $500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-WOOD <br /> VALUATION : $ 4,322.24 <br /> NOTG: WOOD I3URN[NG FIREPLACG REGENCY 131001, <br /> APPLICANT MECHANICAL 54.03 <br /> JACK PIXLEY SWEEPS INC. STATE SURCHARGE MECH (VALUATION) 2.16 <br /> 4179 149TH AVE.NW TOTAL 56.19 <br /> ANDOVER, MN 55304 <br /> (763)422-0011 PAID WITH CC# 5822 <br /> Minnesota State License#: BC183369 <br /> OWIYER <br /> MICHELETTI, TOM <br /> 519 FERNDALE RD N <br /> WAYZATA, MN 55391 <br /> AGREEMENT AND SWORN STATEMENT <br /> The�vork f�or which this permit is issued shall be performed according to <br /> the approvcd 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 rcla[ed work which requires separate <br /> permits. All provisions of laws and ordinances goveming this type of work <br /> shall be compied wi[h whether or not specified herein.'Chis 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 constructioi�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[he State Building Code.This permit may be <br /> revoked at any time f due cause. <br /> ,/ f� / ;° / 13 / / <br /> plicant Permitee Signature Date Issued By Si ture ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED ABOVE. <br />