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CITY OF ORONO * z 0 1 z - 0 1 Z 2 5 * <br /> � 2750 KELLEY PARKWAY �AT� �SSUE�: 12/OS/2012 <br /> ORONO, MN 55356- <br /> ' (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3980 DAHL RD <br /> PIN : 08-117-23-23-0001 <br /> LEGAL DESC : UNPLATTED 08 117 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(> $500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATIOI�I : $ 14,000.00 <br /> NOTL': l HEATILATOR WOOD S"I�OVE[31R50-B <br /> 1 H�AT N GLO NA"T GAS FIREPLACE EVEREST <br /> 1 HEAT N GLO NAT GAS LOG 6033-IPI-NG <br /> APPLICANT <br /> M ECHAN ICAL 175.00 <br /> FIRESIDE HEARTH & HOME STATE SURCHARGE MECH (VALUATION) 7.00 <br /> 2700 FAIRVIEW AVE <br /> ROSEV[LLE, MN 55113 MA[L-IN FEE 2.00 <br /> (65 I)633-2561 TOTAL ]84.00 <br /> Minnesota State License#: 20512060 <br /> OWIVER <br /> MCGLYNN,THOMAS&TONI <br /> 3980 DAHL RD <br /> MOUND, MN 55364- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> State E3uilding Code. This permit is for only the work described and docs <br /> not grant permission for additional or related work which requires scparate <br /> pennits. 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 /> espire and become 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 180 days at any time atter 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 /> `y�CC(.�-� �� l l l _ l <br /> Applicant Permitee Signature Date <br /> Issucd I y Si ature Datc <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED VE. <br />