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� , CITY OF ORONO * z 0 1 6 - 0 PJ 6 3 5 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/02/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4215 NORTH SHORE DR <br /> PIN : 07-117-23-43-0006 <br /> LEGAL DESC : ORCHARD BEACH <br /> : LOT 002 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> COIYSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 2,784.00 <br /> NOTE: GAS FACTORY FIREPLACE-OUTDOOR GREAT ROOM <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 1.39 <br /> FIRESIDE HEARTH&HOME MAIL-IN FEE 2.00 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE, MN 55113 TOTAL 53.39 <br /> (651)633-2561 Payment(s) <br /> Minnesota State License#:mech-20512060 CREDIT CARD 4608 5339 <br /> OWNER <br /> WALDOCH, DOUGLAS&DIANE <br /> 4215 NORTH SHORE DR <br /> MOLJND, MN 55364- <br /> AGREEMENT AND SWORI�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 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 180 days of the date of iss�ance,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 are <br /> requested in conformance with the State Building Cede.This permit may be <br /> revoked at any time for due cause. <br /> i . � � <br /> ' �i � il(%.:� <br /> ( �iLl.[.����, i D � � : <br /> } <br /> Applicant Permitee Signature�� -� Date Issued Signature Date <br />