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6 , CITY OF ORONO * z 0 1 4 - 0 0 0 z z * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OU08/2014 <br /> ORONO, MN 55356- <br /> (952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1840 LAKEVIEW TER <br /> PIN : 27-118-23-42-0010 <br /> LEGAL DESC : LONG LAKE COUNTRY CLUB ADDN <br /> : LOT 005 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 4,000.00 <br /> NOTE: (2)KOZY HEAT GAS FACTORY FIREPLACES <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 2.00 <br /> PRACTICAL SYSTEMS MAIL-IN FEE 2.00 <br /> 4342B SHADY OAK RD TOTAL 54.00 <br /> HOPKINS,MN 55343 <br /> (952)933-1868 Payment(s) <br /> CREDIT CARD 0961 54.00 <br /> OWNER <br /> MERNIK, WILLIAM&LISA <br /> 1840 LAKEVIEW TER <br /> LONG LAKE,MN 55356- <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 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> C 1 ! , �' �/ <br /> Applicant Permitee Signature ate Iss d By Signature Date <br />