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CITY OF ORONO PERM[T NO.: 2010-00990 <br /> ` 2750 KELLEY PARKWAY <br /> � ORONO, MN 55356- �ATE [ssUEn: 10/13/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1055 FERNDALE RD W <br /> PIN : 02-117-23-43-0029 <br /> LEGAL DESC : N/A <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 1,800.00 <br /> NOTE: 1 II:A"T N GLO <br /> G024-[P►-NG <br /> GAS I,OG <br /> APPLICAI�'T MECHANICAL 50.00 <br /> FIRESIDE HEARTH & HOME STATE SURCHARGE MECH(VALUATION) 5.00 <br /> 2700 FAIRV[EW AVE <br /> ROSEVILLE, MN 55113 MAIL-IN FEE 2.00 <br /> (651)633-2561 MISC FEE 0.00 <br /> Minnesota State License#: 20512060 TOTAL 57.00 <br /> OWNER <br /> MCCOURTNEY,GERALD& KAREN <br /> 1055 FERNDALE RD W <br /> WAYZATA, MN 55391 <br /> AGREEMENT AND SWORIv STATEMENT <br /> The�vork for which this permit is issued shall bc performcd according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Duilding Code. This perniit is for only the work described and does <br /> not grant pennission for additional or related work which requires separate <br /> pcnnits. AII provisions of laws and ordinances goveming this type of work <br /> shall be compied with whethcr 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 /> suspcnded for a period of I 80 days at any time atter work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conforniance with�the State Building Code.This permit may be <br /> revoked at any time for due causc. <br /> %��.�r �'y` l l l l <br /> Applicant Permitee Signature Date Issued ignature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E. <br />