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_ . ► CITY OF ORONO * 2 0 1 6 - 0 a 9 1 7 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 08/03/2016 <br /> ORONO,MN 55356- <br /> - (�_>2) 249-4600 FAX: (952)249-4616 <br /> ADDRESS : 265 HOLLANDER RD <br /> PIN : 25-118-23-43-0016 <br /> LEGAL DESC : HOLLY ACRES <br /> : LOT 003 BLOCK 002 <br /> PERMIT TYPE : MECHANICf1L <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 5,537.50 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> (1)HHT GAS FACTORY FIREPLACE <br /> 1 <br /> t <br /> APPLICANT MECHANICAL 69.22 <br /> FIRESIDE HEARTH&HOME STATE SURCHARGE MECH(VALUATION) 2.77 <br /> 2700 FAIRVIEW AVE MAIL-IN FEE 2.00 <br /> ROSEVILLE,MN 55113 TOTAL 73.99 <br /> (651)633-2561 Payment(s) <br /> Minnesota State License#:mech-20512060 CREDIT CARD 4608 73.99 <br /> OWNER <br /> DOEPKE,MARK&CONSTANCE <br /> 265 HOLLANDER RD <br /> WAYZATA,MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall bc 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 dces <br /> not grant permission for additional or related work«hich rcquires separate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be wmpied with whether or not specified hercin.7 his permit will <br /> expire and become null and void if construction authorizcd 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�vork has commenced. <br /> The applicant is responsible for assuring all requircd inspcctions are <br /> requested in conformance with the State Building Code.7'his permit may be <br /> revoked at any time for due cause. <br /> � L-e l r S� $ � �a-� l C� <br /> � � <br /> Applicant Permitee Signature llatc Issued By gnature Date <br />