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'� - ' CITY OF ORONO � <br /> 2750 KELLEY PARKWAY * 2 0 1 2 - P1 1 1 5 9 * <br /> DATE ISSUED: 1U13/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2693 SHADYWOOD RD <br /> PIN : 21-117-23-24-0055 <br /> LEGAL DESC : CHAPMAN ADDN <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 8,000.00 <br /> NOTE: (2)GAS FACTORY PIREPLACGS <br /> (I)GAS GARAGE HEATER <br /> APPLICANT MECHANICAL 100.00 <br /> FIRES[DE HEARTH& HOME STATE SURCHARGE MECH(VALUATION) 4.00 <br /> 2700 FAIRV[EW AVE <br /> ROSEVILLE, MN 55113 MAIL-IN FEE 2.00 <br /> (651)633-2561 TOTAL 106.00 <br /> Minnesota State License#: 20512060 <br /> OWNER <br /> WARNER,JAMES& WENDY <br /> 2693 SHADYWOOD RD <br /> EXCELSIOR, MN 55331- <br /> AGREEMENT AND SWORN STATEMENT <br /> I'he work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable Ci[y approvals,and the <br /> State Building Code. 'l�his permit is for only the work described and does <br /> not grant permission for additional or related work which requires separatc <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 constructien 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 caus <br /> // �/'3 �/2 /l �l 3 �%2 <br /> Applicant Permitee Signature Date [ssu By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />