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CITY OF ORONO * z p� 1 4 - 0 0 0 z 0 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: O1/OS/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1105 FERNDALE RD W <br /> PIN : 02-117-23-43-0033 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0441 <br /> : LOT MB BLOCK MB <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE -GAS <br /> VALUAT[ON : $ 4,500.00 <br /> N07�F,: G�1S I�AC"IORY }'IREPLACI?-tIF.A"I�-N-GLO 0 MODi:L# SL-5�0"I'R-IPI-� <br /> APPLICANT MECHANICAL 56.25 <br /> STATE SURCHARGE MECH (VALUATION) 2.25 <br /> LIND NELSON CONST INC. TOTAL 58.50 <br /> 3794 299TH AVE N W <br /> ISANTI, MN 55040 Payment(s) <br /> (612)282-3006 CREDIT CARD 1955 58.50 <br /> Minnesota State License#: BU1L-BC384640 <br /> OWNER <br /> TRUWIT, CHIP <br /> 1 105 FERNDALE RD W <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be perlormed according[o <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This permit is fbr only the work described and does <br /> not grant permission for additional or related work which requires separate <br /> pennits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specitied herein.This permit will <br /> expire and become null and void if construction authorired 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 /> 'I'he applicant is responsible for assuring all required inspections are <br /> requested in conformance with the State 13uilding Code.This permit may be <br /> revoked at any time for due cause. <br /> � / Q / /3 <br /> flpplicant Permitee Signature Datc Issu By Signature Date <br />