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` CITY OF ORONO PERMIT 1v0.: 2011-00219 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE �ssuEn: 04/14/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 415 DEBORAH DR <br /> PI N : 31-1 18-23-24-0007 <br /> � LEGAL DESC : MCCULLEY FARM <br /> : LOT 005 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> � PROPERTY TYPE : RESIDENTIAL <br /> ! CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 800.00 <br /> NO'[E: GAS FAC CORY FIREPLACE-PETERSON-MODGL NO.G4�-2-24 <br /> APPLICANT MECHANICAL 50.00 <br /> PRACTICAL SYSTEMS STATE SURCHARGE MECH (VALUATION) 5.00 <br /> 4342 B SHADY OAK RD <br /> HOPKINS, MN �5343 TOTAL 55.00 <br /> (952)933-1868 <br /> OWNER <br /> SILLERUD, JON& NORA <br /> 4l5 DEBORAH DR <br /> MAPLE PLA W, MN 55359- <br /> AGREEMENT AND SWORN STATEMENT <br /> 'I'hc work Ibr which this permit is issucd shall bc perlormcd according to <br /> thc approvcd plans�nd s�xci�ications,applicablc City approvals,and thc <br /> State[3uilding Code. "�his permit is for only thc work described and docs <br /> not grant permission for additional or rclatcd work�vhich rcquires scparate <br /> permils. All provisions of la���s and ordinanccs govcrning this rypc of work <br /> shall be compied���ith whether or not specitied herein.'I'his permit will <br /> expire and become null and void if constniction authorized is not <br /> commenced���ithin 180 days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time after work has conunenced. <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 /> e ked at any tin � r due ca _ <br /> � Q- i i ��1�' �'��.����. �" � � /� <br /> Appl nt ermitee Signature Date Issue ��Signature Date � <br /> SEPARATE PERMITS REQUIRED FOR WORK OT R THAN DESCRIBED ABOVE. <br />