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t "�" <br /> CITY OF ORONO * Z 0 1 6 - 0 0 0 9 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OU27/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1790 SHADYWOOD RD <br /> P[N : 17-117-23-21-0025 <br /> LEGAL DESC : SHADY-WOOD <br /> : LOT 020 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 4,302.00 <br /> NOTE: (2)HEAT-N-GLO ESCAPE GAS FIREPLACES <br /> APPLICANT MECHANICAL 53.78 <br /> STATE SURCHARGE MECH(VALUATION) 2.15 <br /> GLOWING HEARTH AND HOME MAIL-IN FEE 2.00 <br /> 100 ELDORADO DRIVE <br /> JORDAN, MN 55352 TOTAL 57.93 <br /> (952)495-2927 Payment(s) <br /> CHECK 22419 57.93 <br /> OWNER <br /> MATEFFY,JOSH&CAITI <br /> 1790 SHADYWOOD RD <br /> WAY'LATA,MN 55391- <br /> AGREEMENT AIVD 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 l80 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 /> �L�L_u��e� �-e�� � f i �7 i l �� <br /> Applicant Per itee Signature ' Date Issued ignature Date <br /> �i <br />