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� . � <br /> CITY OF ORONO * 2 0 1 6 — fd 1 3 7 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/28/2016 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3188 NORTH SHORE DR <br /> PIN : 09-117-23-32-0011 <br /> LEGAL DESC : CRYSTAL BAY PARK <br /> : LOT 000 BLOCK 004 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 2,500.00 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> GAS FIREPLACE SET AND VENT ONLY---GAS BY OTHERS <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 1.25 <br /> WALTER MECHANICAL,INC. MAIL-IN FEE 2.00 <br /> 517 WEST TRAVELERS TRAIL <br /> BURNSVILLE,MN 55337 TOTAL 53.25 <br /> (952)895-1992 Payment(s) <br /> Minnesota State License#:mech-MB003448 CHECK 006191 53.25 <br /> OWNER <br /> RUCINSKI,MICHEAL&HOLLY <br /> 3188 NORTH SHORE DR <br /> WAYZATA,MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this pertnit 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 dces <br /> not grant permission for additionai 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 suthorized 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 time for due cause. � <br /> --0"'�—� <br /> Applicant Permitee Signature Date Issued B ignature Date <br />