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� CITY OF ORONO PERMIT NO.: 2011-01501 <br /> i 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE IssuED: 12/OU2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1635 BOHNS POINT RD <br /> PIN : 17-117-23-11-0006 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0565 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VAWATION : $ 8,000.00 <br /> NO"I'E: H-N-G RED 60 GAS FP <br /> APPLICANT MECHANICAL 100.00 <br /> FIRES[DE HEARTH&HOME STATE SURCHARGE MECH(VALUATION) 4.00 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE, MN 55113 MAIL-IN FEE 3.00 <br /> (651)633-2561 MISC FEE 0.00 <br /> Minnesota State License#: 20512060 TOTAL ]07.00 <br /> OWNER <br /> KOZLAK, STNICK&JODEE <br /> 1635 BOHNS PT RD <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 /> permi[s. All provisions of laws and ordinances governing this type of work <br /> shall be compicd with whether or no[specified herein.This permit will <br /> expire and bccome null and void if construction authorized is not <br /> commenced within 180 days of the date of issuance,or if cons[ruction 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 lhe State Building Code.This permi[may be <br /> revoked at any time for due cause. <br /> `'�vt1.t-�� W`' / / <br /> Applicant Permitee Signature Date � � <br /> Issued By i nature ate <br /> SEPARATE PERM[TS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E. <br />