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1,1 11 <br /> t , CITY OF ORONO * 20 1 6 - 0 1 320 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/17/2016 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1380 ORONO LA <br /> PIN : 02-117-23-34-0012 <br /> LEGAL DESC : REG.LAND SURVEY NO. 1350 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 4,500.00 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> MENDOTA GAS FACTORY FIREPLACE <br /> APPLICANT MECHANICAL 56.25 <br /> STATE SURCHARGE MECH(VALUATION) 2.25 <br /> TWIN CITY FIREPLACE CO. MAIL-IN FEE 2.00 <br /> 6916 WASHBURN AVE. S. <br /> MINNEAPOLIS,MN 55423- TOTAL 60.50 <br /> (612)282-2684 Payment(s) <br /> CHECK 21389 60.50 <br /> OWNER <br /> Luke Beltnick Revocable Trust <br /> BELTNICK,LUKE&ELENA <br /> 3018 EMERSON AVE S <br /> MINNEAPOLIS,MN 55408- <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. ,Q <br /> (1IA. -Ce4— e /o i l -7 / <br /> Applicant Permitee Signature Date Issued By 'gnature Date <br />