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CITY OF ORONO I11 �' I I !I <br /> * 2018 - 00359 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 03/27/2018 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 129 CHEVY CHASE DR <br /> PIN : 36-118-23-41-0020 <br /> LEGAL DESC : HILL O'WAY MANOR <br /> : LOT 015 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 5,300.00 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> KOZY HEAT GAS FIREPLACE <br /> MODEL-SP34-MV <br /> APPLICANT MECHANICAL 66.25 <br /> STATE SURCHARGE MECH(VALUATION) 2.65 <br /> PRACTICAL SYSTEMS MAIL-IN FEE 2.00 <br /> 4342B SHADY OAK RD <br /> HOPKINS,MN 55343 TOTAL 70.90 <br /> (952)933-1868 Payment(s) <br /> Minnesota State License#:mech-MB003510 CHECK 1981 70.90 <br /> OWNER <br /> SAHLSTROM,DAVID&JEAN <br /> 129 CHEVY CHASE DR <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 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 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 are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> • <br /> C O 0 3 /a`7 /fig <br /> Applicant Permitee Signature Date Issued By Si y: e Date <br />