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CITY OF ORONO * 2 0 1 z - a 0 z 8 0 * <br /> ` 2750 KELLEY PARKWAY DATE ISSUED: 04/12/2012 <br /> � ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 75 LEAF ST <br /> PIN : OS-117-23-11-0014 <br /> LEGAL DESC : GRAHAM HILL PRESERVE 3 <br /> : LOT 1 BLOCK 3 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-WOOD <br /> VALUATION : $ 3,000.00 <br /> NOTE: HEATILATOR CI80 <br /> APPLICANT MECHANICAL 50.00 <br /> FIRESIDE HEARTH&HOME STATE SURCHARGE MECH(VALUATION) 1.50 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE,MN 55113 MAIL-IN FEE 2.00 <br /> (651)633-2561 TOTAL 53.50 <br /> Minnesota State License#:20512060 <br /> OWNER <br /> KAPSNER,JASON&JULIE <br /> 760 DICKEY LAKE ROAD <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 Ciry 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 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 /> The applicant is responsible for assuring all required inspections are <br /> requested in confortnance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> / / / / <br /> Applicant Permitee Signature Date Issued By Si ature ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO <br />