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11111111111111111111111 <br /> CITY OF ORONO * 2012 - 00843 * <br /> r 2750 KELLEY PARKWAY DATE ISSUED: 08/27/2012 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 505 WILLOW DR S <br /> PIN : 04-117-23-41-0012 <br /> LEGAL DESC : MAJESTIC SPRUCE ADDITION <br /> : LOT 2 BLOCK 1 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE FIREPLACE-GAS <br /> VALUATION $ 2,700.00 <br /> NOTE: 1 HEAT N GLO COSMO I30 INSERT <br /> APPLICANT MECHANICAL 50.00 <br /> FIRESIDE HEARTH&HOME STATE SURCHARGE MECH(VALUATION) 1.35 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE,MN 55113 MAIL-IN FEE 2.00 <br /> (651)633-2561 MISC FEE 0.00 <br /> Minnesota State License#:20512060 TOTAL 53.35 <br /> OWNER <br /> MOORHOUSE& SHAYNE ERNZER,MARK <br /> 505 WILLOW DR S <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 fondue cause. <br /> Applicant Permitee Signature Date Issued By Si ture ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO . <br />