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CITY OF ORONO �c Z 0 1 6 — 0 PJ 5 4 P1 * <br /> . � 2750 KELLEY PARKWAY DATE ISSUED: OS/18/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1629 BOHNS POINT RD <br /> PIN : ]7-117-23-11-0005 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0565 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 4,000.00 <br /> NOTE: 2 GAS FIRPLACE/HEAT&GLO SUPREME-I30-C/ KOZY HEAT CSK-25 <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 2.00 <br /> GLOWING HEARTH AND HOME MAIL-IN FEE 2.00 <br /> 100 ELDORADO DRIVE TOTAL 54.00 <br /> JORDAN, MN 55352 <br /> (952)495-2927 Payment(s) <br /> CHECK 23048 54.00 <br /> OWNER <br /> AMPLATZ, CAROLINE <br /> 345 LEAF ST <br /> P.O. BOX 619 <br /> WAYZATA, MN 55391- <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 approvais,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 1 SO 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> ,> `�� I� <br /> ��- ►% �u�--�'� � � , <br /> pplic n ermitee ignature Date Is ued Signature Date <br />