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-' • CITY OF ORONO * z 0 1 3 - 0 0 3 9 7 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OS/22/2013 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 495 OXFORD RD <br /> PIN : OS-117-23-41-0011 <br /> LEGAL DESC : STIELOWS ADDN <br /> : LOT 003 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 15,000.00 <br /> NOTE: 2 HEAT N GLO GAS FP <br /> 2 HEAT N GLO WOOD FIREPLACES <br /> APPLICANT MECHANICAL 187.50 <br /> GLOWING HEARTH AND HOME STATE SURCHARGE MECH(VALUATION) 7.50 <br /> 100 ELDORADO DRIVE <br /> JORDAN,MN 55352 MAIL-IN FEE 2.00 <br /> (952)495-2927 TOTAL 197.00 <br /> OWNER <br /> SAMPLE,MIKE&ANNE <br /> 1449 BAY RIDGE 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. 7'his 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 aze <br /> requested in conformance with tHe State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> `'lu�t.t.� �lt, l l l l <br /> Applicant Permitee Signature Date Issued By S' ature --- Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER N DESCRIBED A VE. <br />