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t d CITY OF ORONO liiiiiiiiiiiiiiiiiiiiillillillillillillilliiiim <br /> 215 - 00400 * <br /> 2750 KELLEY PARKWAY * DANE ISSUED: 04/09/2015 <br /> ORONO,MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 581 NORTH STREAM RD <br /> PIN : 25-118-23-34-0005 <br /> LEGAL DESC : NORTH STREAM <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE MECHANICAL(>$500) <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 10,254.15 <br /> NOTE: GAS FIREPLACE-HHT-PIER-36TR-IPI <br /> APPLICANT MECHANICAL 128.18 <br /> STATE SURCHARGE MECH(VALUATION) 5.13 <br /> FIRESIDE HEARTH&HOME MAIL-IN FEE 2.00 <br /> 2700 FAIRVIEW AVE TOTAL 135.31 <br /> ROSEVILLE,MN 55113 <br /> (651)633-2561 Payment(s) <br /> Minnesota State License#:mech-20512060 CREDIT CARD 4608 135.31 <br /> OWNER <br /> LARSON,DAVID&JANIS <br /> 581 NORTH STREAM RD <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 /> 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 /> � Lf / <br /> !/ <br /> Applicant Pehrfit6e Signature Date Issued y Signature Date <br />