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, � <br /> CITY OF ORONO * Z 0 1 4 - 0 0 2 7 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 04/04/2014 <br /> ORONO, MN 55356- � <br /> (952) 249-4600 FAX: (952 249-4616 <br /> ADDRESS : 1065 FERNDALE RD W <br /> PIN : 02-117-23-43-0021 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1372 <br /> ; LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-WOOD <br /> VALUATION : $ 6,000.00 <br /> NOTE: WOOD BURNMG FIREPLACE-QUADRAFIRE FACTORY BUILT-MODEL#7100FR-BK-B <br /> APPLICANT MECHANICAL 75.00 <br /> STATE SURCHARGE MECH(VALUATION) 3.00 <br /> GLOWING HEARTH AND HOME MAIL-IN FEE 2.00 <br /> 100 ELDORADO DRIVE TOTAL 80.00 <br /> JORDAN,MN 55352 <br /> (952)495-2927 Payment(s) <br /> CHECK 18671 80.00 <br /> OWNER <br /> DETOR, ELIZABETH&LUCAS <br /> 1065 FERNDALE RD W <br /> WAYZATA, MN 55391- <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 goveming this rype 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> / �� / / / <br /> Applicant Permitee Signature te Issue y Signature Date <br />