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•�" CITY OF ORONO * Z 0 1 5 - 0 0 1 6 7 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 02/09/2015 <br /> ORONO,MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 560 KOKESH FARM RD <br /> pI� : 31-118-23-11-0012 <br /> LEGAL DESC : KOKESH FARMS <br /> : LOT 003 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATI01�1 : $ 2,500.00 <br /> NOTE: PETERSON GAS FIREPLACE <br /> / <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 1.25 <br /> PRACTICAL SYSTEMS MAIL-IN FEE 2.00 <br /> 4342B SHADY OAK RD TOTAL 53Z5 <br /> HOPKINS,MN 55343 <br /> (952)933-1868 Payment(s) <br /> CREDIT CARD 5815 53.25 <br /> OWNER <br /> SISKA,BRIAN&NANCY <br /> 560 KOKESH FARM RD <br /> MAPLE PLAIN,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 /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances goveming 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. n,� <br /> IGIi <br /> �- L C��Y�C�-1�1 �� R � <br /> Applicant Permitee Sig ature Date Issued By Signature Date <br />