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r r CITY OF ORONO * 2 0 1 6 - PJ 1 3 8 8 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 1UO2/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1885 CONCORDIA ST <br /> PIN : 17-117-23-23-0002 <br /> LEGAL DESC : COFFEES ADDN TO SHADY WOOD LAK <br /> : LOT 000 BLOCK 000 <br /> PERM[T TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 29,419.10 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON S[TE AT F[NAL INSPECT[ON. <br /> (4)HHT GAS F[REPLACES <br /> MODELS: SLR-D,TRUE-42,6000CL,AND TRUE-42 <br /> APPLICANT MECHANICAL 367.74 <br /> STATE SURCHARGE MECH(VALUATION) 14.71 <br /> FIRESIDE HEARTH&HOME MAIL-IN FEE 2.00 <br /> 2700 FAIRVtEW AVE <br /> ROSEVILLE MN 55113 TOTAL 384.45 <br /> (651)633-2561 Payment(s) <br /> Minnesota State License#: mech-20512060 CREDIT CARD 4608 384.45 <br /> OWNER <br /> KAISER, BERNARD&CAROLYN <br /> 2855 PROVIDENCE PLACE <br /> fNDEPENDENCE,MN 55359- <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 /> no[grant permission for additional or related work which requires separate <br /> permits. All provisions of taws 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 /> conunenced 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 the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> r <br /> � �� ll, �/� <br /> Applicant Permitee Signature Date Issued By S� n ture Date <br />