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CITY OF ORONO 1*111311111 IIOI 11 I 111 I I I1I <br /> 20 2750 KELLEY PARKWAY DATE ISSUED: 03/02/2018 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 2695 COUNTRYSIDE DR W <br /> PIN : 04-117-23-13-0005 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 005 BLOCK 003 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 2,000.00 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> GAS FACTORY FIREPLACE-HEAT-N-GLO <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 1.00 <br /> WESTAIR INC. MAIL-IN FEE 2.00 <br /> 11184 RIVER ROAD NE <br /> HANOVER,MN 55341 TOTAL 53.00 <br /> (763)498-8071 Payment(s) <br /> Minnesota State License#:mech-MB003525 CREDIT CARD 8564 53.00 <br /> OWNER <br /> BICKETT, SCOTT&HOLLY <br /> 2695 COUNTRYSIDE DR W <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 are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> r 4<e( -1-cb <br /> Applicant Permitee Signature Date Issued JSignature Date <br />