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� CITY OF ORONO * 2 0 1 3 - 0 0 9 7 0 * <br />. '" 2750 KELLEY PARKWAY DATE ISSUED: 09/18/2013 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952)249-4616 <br /> ADDRESS : 3625 JACOBS MILL RD <br /> PIN : 32-118-23-24-0013 <br /> LEGAL DESC : JACOBS MILL <br /> : LOT 003 BLOCK 002 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 7,000.00 <br /> NOTE: (2)GAS FIREPLACES-LENNOX <br /> (1)WOOD BURNING FIREPLACE <br /> GAS LINES BY OTHER CONTRACTOR <br /> APPLICANT MECHANICAL 87.50 <br /> FERGUSON STATE SURCHARGE MECH(VALUATION) 3.50 <br /> 925 DECATUR AVENUE <br /> GOLDEN VALLEY,MN 55427- TOTAL 91.00 <br /> (763)367-0317 PAID WITH CASH 91.00 <br /> OWNER <br /> SCHMID,KURT&CAROL <br /> 2950 ISLAND VIEW DRIVE <br /> MOLJND,MN 55364- <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 sepazate <br /> permits. All provisions of laws and ordinances goveming 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any ti e for due cause. / — <br /> i /�i / o�, f�-�-- cli � �'i l <br /> lic Permitee Signature Date Issue By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />