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CITY OF ORONO * 2 0 1 3 - 0 0 2 9 1 * <br /> 2750 KELLEY PARKWAY pATE ISSUEn: 04/30/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 106 CHEVY CHASE DR <br /> PIN : 36-ll 8-23-41-0033 <br /> LEGAL DESC : HILL O'WAY MANOR <br /> : LOT 028 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 3,967.00 <br /> NOTE: UAS FACTORY FIREPLnCE-MENDOTA-MODEL NO. FV44I <br /> APPLICANT MECHANICAL 50.00 <br /> TWIN CITY FIREPLACE CO. STATE SURCHARGE MECH(VALUATION) 1.98 <br /> 6916 WASHBURN AVE. S. <br /> MINNEAPOLIS, MN 55423- MAIL-IN FEE 2.00 <br /> (612)282-2684 TOTAL 53.98 <br /> PAID WITH CC# 5658 <br /> OWNER <br /> JOHNSON, MR. & MRS. <br /> 106 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 Ciry approvals,and the <br /> State Building Code. This permit is tbr only the work described and does <br /> not grant permission for additional or related work which requires separa[e <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or no[specified herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within l80 days of the date of issuance,or if construction is <br /> suspended for a period of I 80 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 /> ��✓�2��v� `���°� /3 �30 � <br /> Applicant Permitee Signature Date Issued Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />