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r CITY OF ORONO * 2 0 1 5 — 0 1 5 8 0 * <br /> ` 2750 KELLEY PARKWAY DATE ISSUED: 12/18/2015 <br /> �a ORONO, MN 55356- <br /> (952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 335 HOLLANDER RD <br /> PIN : 25-118-23-43-0009 <br /> LEGAL DESC : REG.LAND SURVEY NO. 1429 <br /> : LOT 000 BLOCK 000 <br /> PERMTT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 4,997.65 <br /> NOTE: HHT GAS FIREPLACE <br /> APPLICANT MECHANICAL 62.47 <br /> STATE SURCHARGE MECH(VALUATION) 2.50 <br /> FIRESIDE HEARTH&HOME MAIL-IN FEE 2.00 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE,MN 55113 TOTAL 66.97 <br /> (651)633-2561 Payment(s) <br /> Minnesota State License#:mech-20512060 CREDIT CARD 4608 66.97 <br /> OWNER <br /> ERICKSON,WALTER&NANCY <br /> 335 HOLLANDER RD <br /> WAYZATA,MN 55391 <br /> AGREEMENT AND 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 sepazate <br /> permiu. All provisions of laws and ordinances goveming 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 issuance,or if construction is <br /> suspended for a period of 180 days at any time after work has commenced. <br /> 1'he applicant is responsible for assuring all required inspections aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> �.. � <br /> �cc,ti��-� � �- 1���� �� i l8 � /S <br /> Applicant Permitee Signature Date Issued By Si ature Date <br />