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• CITY OF ORONO * 2 0 1 5 - 0 0 0 1 1 * <br /> l 2750 KELLEY PARKWAY DATE ISSUED: OU05/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1165 FERNDALE RD W <br /> PIN : 02-117-23-43-0026 <br /> LEGAL DESC : NORTH SHORE COTTAGE ACRES LAKE <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : MECHANICAL- MULTIPLE <br /> VALUATION : $ 15,000.00 <br /> NOTE: HEATING SYSTEM <br /> KITCHEN EXHAUST <br /> GAS LINE FOR FIREPLACE <br /> APPLICANT MECHANICAL 187.50 <br /> STATE SURCHARGE MECH(VALUATION) 7.50 <br /> SELECT MECHANICAL SERVICES [NC. TOTAL 195.00 <br /> 6219 CAMBRIDGE ST <br /> ST. LOUIS PARK,MN 55416- Payment(s) <br /> (952)926-4488 CHECK 3814 195.00 <br /> OWNER <br /> BROOK, ROBERT <br /> 1165 FERNDALE RD W <br /> WAYZATA, MN 55391- <br /> AGREEMENT AIYD SWORN STATEMENT <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. AII 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 null and void if construc[ion authorized is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of I 80 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 Sta[e Bui mg Code.This permit may be <br /> revoked at an time for due c se. �� ��N' <br /> � �� <br /> i � / <br /> ' - � � / ` � ��f � i� i � <br /> ., .�`-.1..�.�;,- <br /> Applicant Permitee Signature Date � Issue By Si ature Date <br />