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CITY OF ORONO PERMIT NO.: 2011-00095 <br /> 2750 KELLEY PARKWAY <br /> - ORONO, MN 55356- DATE ISSUEu: 02/10/2011 <br /> • 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 125 CHEVY CHASE DR <br /> PIN : 36-118-23-41-0018 <br /> LEGAL DESC : HILL O'WAY MANOR <br /> : LOT 013 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(> $500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 700.00 <br /> N01'G: GAS LINE GAS LOG-MAIN FLOOR <br /> APPLICANT MECHANICAL 50.00 <br /> AIR QUALITY SERVICES, INC. STATE SURCHARGE MECH (VALUATION) 5.00 <br /> 6221 CAMBRIDGE STREET <br /> BOX A6 MISC FEE 0.00 <br /> ST LOUIS PARK, MN 55416- TOTAL 55.00 <br /> (952)9?5-3835 <br /> OWNER <br /> GRIFFIN, ROB & KIM <br /> 125 CHEVY CHASE DR <br /> WAYZATA, MN 55�91- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this pennit is issued shall be periormed accordinc to <br /> the approved plans and specitications.applicable City approvals,and the <br /> State f3uilding Code. 'I�his permit is lor only the work dcscribed and does <br /> not grant permission for additional or related work�vhich requires scparate <br /> permits. All provisions of Itnvs and ordinances governing this type uf work <br /> shail be compicd�cith�chcther or not specitied herein."I'his permit will <br /> espire and become null and void if construction authorized is not <br /> conunenced�vithin 180 days of lhe date of issuance,or if construction is <br /> suspendcd for a period of 180 days at any time aftcr�vork has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with the State L3uilding Code.This permit may be <br /> revokcd at any tii ic fpr�lue causa � <br /> � -, I : <br /> c,�� � .,=6�,���%+'�'i�"� l l <br /> / / <br /> Applicant Permitee Signature Date Issuc By i nature D <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHE THAN DESCRIBED ABOV <br />