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w <br /> , : CITY OF ORONO * 2 0 1 5 - 0 0 2 7 7 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 03/09/2015 <br /> ORONO, MN 55356- <br /> (952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1165 FERNDALE RD W <br /> PIN : 02-117-23-43-0026 <br /> LEGAL DESC : NORTH SHORE COTTAGE ACRES LAKE <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> COI�ISTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 8,000.00 <br /> NOTE: (1)MARQUIS GAS FACTORY FIREPLACE <br /> APPLICANT MECHAMCAL ]00.00 <br /> STATE SURCHARGE MECH(VALUATION) 4.00 <br /> TWIN CITY FIREPLACE STONE CO INC TOTAL 104.00 <br /> 6521 CECILIA CIR Payment(s) <br /> ED[NA, MN 55439- CHECK 201240 104.00 <br /> (952)941-2685 <br /> Minnesota State License#: mech-MB682977 <br /> OWNER <br /> BROOK,ROBERT <br /> 1165 FERNDALE RD W <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 /> net grant permission for additional or rela[ed 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 permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within l80 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 the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> C �-�-��- � i� ��� <br /> Applicant Permitee ' nature Date Issu d y Signature Date <br />