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CITY OF ORONO 1 I 1 I 1 I1 11111111111111111111111 <br /> 2750 KELLEY PARKWAY * Z 0 1 7 - 0 1 5 8 <br /> DATE ISSUED: 12/06/22 017 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 3860 NORTH SHORE DR <br /> PIN : 08-117-23-33-0095 <br /> LEGAL DESC : CRYSTAL BAY VIEW <br /> : LOT 000 BLOCK 007 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 3,549.00 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> EMPIRE GAS FIREPLACE <br /> MODEL DVD 36 <br /> APPLICANT MECHANICAL 50.00 <br /> D J'S HEATING&AIR STATE SURCHARGE MECH(VALUATION) 1.77 <br /> 6060 LABEAUX AVE TOTAL 51.77 <br /> ALBERTVILLE,MN 55301 Payment(s) <br /> (763)497-2661 CHECK 6708 51.77 <br /> Minnesota State License#:HVAC-Mb002987 <br /> OWNER <br /> SIMMONS,BRETT <br /> 3860 NORTH SHORE DRIVE <br /> MOUND,MN 55364- <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 are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoke. • time for due cause. • <br /> !,� •v. /ue : <br /> .,� ✓� //7 ��i:S-� / (e / 7 <br /> � <br /> App icant Permitee Signature Date Issued Signature Date <br />