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� • CITY OF ORONO PERMIT NO.: Zoiaoo696 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISsuEn: 08/1 U2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1200 PHILLIPS DR <br /> PIN : 27-118-23-32-0009 <br /> LEGAL DESC : PHILLIPS WOODLAND TERRACE <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 2,930.00 <br /> NOTE: FACTORY GAS FIREPLACE <br /> HEATILATOR-MODEL NO CD4236IR-C <br /> APPLICANT MECHANICAL 50.00 <br /> AUTOMATIC GARAGE DOOR&FIREPLACE STATE SURCHARGE MECH(VALUATION) 5.00 <br /> 8900 109TH AVE N <br /> SUITE 1000 TOTAL 55.00 <br /> CHAMPLIN, MN 55316 <br /> (763)571-2525 <br /> OWNER <br /> JOHNSON,CHRISTIAN&BETH <br /> 1200 PHILLIPS DR <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 no[specified hecein.This permi[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 /> cequested in conformance with the State Building Code.This permit may be <br /> revoked�t `ny tim for due cause. <br /> /���+���' �// / �D g i /�-�- /D <br /> icant Permitee Signature Date Issu d y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />