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'� CITY OF ORONO * 2 0 1 6 - 0 0 0 7 8 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: OU25/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3640 JACOBS MILL RD <br /> PIN : 32-118-23-24-0010 <br /> LEGAL DESC : JACOBS MILL <br /> : LOT 004 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 4,215.00 <br /> NOTE: NEW ADDITIONAL:GAS FIREPLACE(HHT) <br /> APPLICANT MECHANICAL 52.69 <br /> STATE SURCHARGE MECH(VALUATION) 2.11 <br /> FIRESIDE HEARTH&HOME MAIL-IN FEE 2.00 <br /> 2700 FAIRVIEW AVE TOTAL 56.80 <br /> ROSEVILLE, MN 55113 <br /> (651)633-2561 Payment(s) <br /> Minnesota State License#: mech-20512060 CREDIT CARD 4608 56.80 <br /> OWNER <br /> HOFFMAN, KEITH&MARY <br /> 3640 JACOBS MILL RD <br /> LONG LAKE, MN 55356- <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 /> not grant permission for additional or related 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 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 /> � ' <br /> 1 1 � <br /> � -� � � � = -- '. <br /> � � 1 1 i ,�_�, � �?Ct�� ��.— Jt_ � � / _ <br /> ,�, <br /> Applicant Permitee Signature Date Issued By Signature Date <br />