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• CITY OF ORONO * Z 0 1 3 — 0 0 2 9 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 04/29/2013 <br /> � ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 800 FOREST ARMS LA <br /> PIN : 07-117-23-12-0004 <br /> LEGAL DESC : FOREST ARMS <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(> $500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 3,800.00 <br /> NOTE: HEAT N GLO 550 TRS <br /> � - _ <br /> APPLICANT MECHANICAL 50.00 <br /> FIRESIDE HEARTH& HOME STATE SURCHARGE MECH(VALUATION) 1.90 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE, MN 55113 MAIL-IN FEE 2.00 <br /> (651)633-2561 TOTAL 53.90 <br /> Minnesota State License#: 20512060 <br /> OWNER <br /> MAYES, CLIFFORD A& BRENDA L <br /> 800 FOREST AIZMS LA <br /> MOUND, MN 55364- <br /> AGREEMENT AND SWORN STATEMENT <br /> "I�he��ork for which this permit is issued shall be performed according to <br /> the approved plans and specifica[ions,applicable City approvals,and the <br /> State Building Code. This permi[is for only the work described and does <br /> not grant permission 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 specified herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 days of the date of issuanee,or if construction is <br /> suspended for a period of 180 days at any[ime after work has commcnced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance�ith the State Building Code.This permi[may be <br /> revoked at any time for due cause. <br /> `{��t� �K. / / �/ I'V`,cC-� l l <br /> Applicant Permitee Signature Date Issued By Si ture ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER T AN DESCRIBED A E. <br />