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. <br /> CITY OF ORONO * Z 0 1 2 — 0 fd 9 8 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/04/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3458 NORTH SHORE DR <br /> P[N : 08-117-23-43-0025 <br /> LEGAL DESC : LYD[ARDS PARK LAKE MTKA <br /> : LOT 019 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 5,000.00 <br /> NOTE: HEAT N'GLO SLSSOTRS <br /> APPLICANT MECHAN[CAL 62.50 <br /> COUNTRYSIDE HEATING& COOLING STATE SURCHARGE MECH(VALUATION) 2.50 <br /> 6511 HWY 12 TOTAL 65.00 <br /> MAPLE PLAIN,MN 55359 <br /> (763)479-1600 <br /> OWNER <br /> LINDBLOOM, MARY& DEAN <br /> 3458 NORTH SHORE DR <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed accordin�to <br /> the approved plans and specitications,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 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 afrer work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested�conformanae with the State Building Code.This permit may be <br /> revoked;�a�)/any time or d cause. <br /> ,\//� � / /LG_J <br /> ' `�'`�v� /� / L' � �-� � � 4'7`,. �.�.. �...' L..YY�L= i'"'� � �r`� .._�^ � <br /> Applicant Permitee S�gnature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />