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� �. CITY OF ORONO PERMIT NO.: 2012-00073 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 02/07/2012 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 117 CHEVY CHASE DR <br /> P(N : 36-118-23-41-0014 <br /> � LEGAL DESC : HILL O'WAY MANOR <br /> : LOT 009 BLOCK 001 <br /> NERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 3,700.00 <br /> NO"I'E: 1{F;AT N GLO GAS FACTORY FIREPLACE-MODEL#ESCAPE 130 <br /> APPLICANT MECHAN[CAL 50.00 <br /> FIRESIDE HEARTH & HOME STATE SURCHARGE MECH (VALUATION) 1.85 <br /> 2700 FAIRVIEW AVE TOTAL 51.85 <br /> ROSEVILLE, MN 55113 <br /> (651)633-2561 <br /> Minnesota State License#: 20512060 <br /> OWNER <br /> ARTHUR,ALAN& CAROL <br /> 1 17 CHEVY CHASE DR <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> Chc work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable Ciry 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 /> pennits. Ail provisions of laws and ordinances governing this type of work <br /> shall be compied with whe[her 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 a[any time after work has commenced. <br /> I'he applican[is responsible for assuring all required inspections are <br /> requested in conformance with[he State Building Code.This permi[may be <br /> revoked at any time for due cause. <br /> ����-� � i 7 i /2 �_. �i � i� <br /> Applicant Permitee Signature Date Issue y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />