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,• � CITY OF ORONO PERMIT NO.: 20�0-oo66s <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE IssuEn: 08/04/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1225 DICKENSON ST <br /> PIN : 02-117-23-31-0048 <br /> LEGAL DESC : MINNETONKA BLUFFS <br /> : LOT 000 BLOCK 016 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTIOI�1 TYPE : FIREPLACE- WOOD <br /> VALUATION : $ 2,880.00 <br /> NOTE: WOOD BURNING FIREPLACE-BRAND-H�AT-N-GLO-MODEL NO. MONTANA 42 <br /> APPLICANT MECHANICAL 50.00 <br /> FIRESIDE HEARTH& HOME STATE SURCHARGE MECH(VALUATION) 5.00 <br /> 2700 FAIRVIEW AVE TOTAL 55.00 <br /> ROSEVILLE,MN 55113 <br /> (651)633-2561 <br /> Minnesota State License#: 20512060 <br /> OWNER <br /> GIEL, TOM& SARAH <br /> 1225 DICKENSON STREET <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 reiated 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 pern�it 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 after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with[he State Building Code.This permi[may be <br /> revoked at any time for due cause. <br /> ��--1�� i � l l /O <br /> Applicant Permitee Signature Date Iss By �gnature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK O HER THAN DESCRIBED ABOVE. <br />