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CITY OF ORONO PERMIT NO.: 2009-00863 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE IssuEn: 12/OU2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 200 BEDERWOOD DR <br /> PIN : OS-117-23-12-0027 <br /> LEGAL DESC : AUDITOR'S SUBD.NO.203 <br /> : LOT MB BLOCK MB <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENT[AL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 3,400.00 <br /> NOTE: TWO GAS FIREPLACES-BRAND: HENT-N-GLO-MODEL NO: 750 TRS'S <br /> APPLICANT MECHANICAL 50.00 <br /> FIRESIDE HEARTH&HOME STATE SURCHARGE MECH(VALUATION) 1.70 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE, MN 55113 MAIL-IN FEE 2.00 <br /> (651)633-2561 TOTAL 53.70 <br /> Minnesota State License#: 20512060 <br /> OWNER <br /> AZAD, ALISHAH <br /> 200 BEDERWOOD DR <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> Thc work for which this permit is issued shall be performed according to <br /> the approved plans and specifica[ions,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 afrer 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 /> �12i a�� /�ou �/� � � ��✓%t/yuc� i.z..� v/ � a y <br /> Applicant Permitee Signature Date Iss d By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />