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� <br /> � � � CITY OF ORONO PERMIT NO.: 2009-00574 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE IssuEv: 09/10/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2745 KELLY AVE <br /> PIN : 21-117-23-23-0028 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0891 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-WOOD <br /> VALUATION : $ 3,000.00 <br /> NOTE: 1 WOOD BURNING[NSERT QUADRA FIRE 2700I <br /> APPLICANT MECHANICAL 50.00 <br /> FIRESIDE HEARTH& HOME STATE SURCHARGE MECH(VALUATION) 1.50 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE, MN 55113 TOTAL 51.50 <br /> (651)633-2561 <br /> Minnesota State License#: 20512060 <br /> OW1vER <br /> WOOD,JAY&BARBARA <br /> 2745 KELLY AVE <br /> EXCELSIOR, MN 55331 <br /> AGREEMENT AND SWORN STATEMENT <br /> The 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 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. 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 issuance,or if construction 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 the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> � — `�-� � l /U i G �j l l <br /> Applicant Pe itee Signature Date Issued By gnature ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOu . <br />