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. <br /> � CITY OF ORONO * z 0 1 3 - 0 0 0 9 B * <br /> 2750 KELLEY PARKWAY UATE ISSUED: 02/06/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2590 COUNTRYSIDE DR <br /> PIN : 04-117-23-11-0010 <br /> LEGAL DESC : COUNTRYSIDE MANOR 2ND ADDN <br /> : LOT 002 BLOCK 002 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 4,400.00 <br /> NOTI?: GAS FACTORY FIRGPLi1CG <br /> BRAND: ki-N-G <br /> MODGL: GSCAPE- I3�-C <br /> APPLICANT MECHAN[CAL 55.00 <br /> FIRES[DE HEARTH & HOME STATE SURCHARGE MECH (VALUATfON) 2.20 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE, MN 551 13 MAIL-IN FEE 2.00 <br /> (651)633-2561 TOTAL 59.20 <br /> Minnesota State License#: 20512060 <br /> OWNER <br /> FIELD,JAMES& CHRISTINE <br /> 2590 COUNTRYSIDE DR <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work tbr which this permit is issucd shall be performcd according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> State E3uilding Code. "I'his permit is lor only the work described and does <br /> not grant permission for additional or related work which requiros separate <br /> permits. All provisions of laws and ordinances governing Uiis type of work <br /> shall be compicd with whether or not specitied herein.This pennit 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 conformancc with the State Building Code.'1'his permit may bc <br /> revoked at any time for duc caus�. <br /> �2� � / /.-� 02/ !� / /� <br /> App icant Permitee Si ure l�atc Issu� E3y Si�nature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCR[BED ABOVE. <br />