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� � � CITY OF ORONO PERMIT NO.: 2009-00676 <br /> 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE ISSUEn: 10/06/2009 , <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2660 PHEASANT RD <br /> PIN : 21-117-23-23-0022 <br /> LEGAL DESC : PHEASANT LAWN <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 3,000.00 <br /> NOTE: KOZY HEAT GAS FACTORY FIREPLACE-MODEL NO.JACKSON 911 <br /> APPLICANT MECHANICAL 50.00 <br /> GAS LINE PLUS,INC. STATE SURCHARGE MECH(VALUATION) 1.50 <br /> 1661 LONSDALE BLVD <br /> NORTHFIELD,MN 55057- TOTAL 51.50 <br /> (612)4144243 <br /> OWNER <br /> HAYHURST,GREGORY&GAYLE <br /> 2660 PHESANT RD <br /> EXCELSIOR,MN 55331 <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 dces <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 applic is respo �ble for assuring all required inspections aze <br /> requested' nfo ance with the State Building Code.This permit may be <br /> revoked t y ' e for due . <br /> ��� �-fl /p� v�I p 7� <br /> Ap ic Permitee Signature Date Iss By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />