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� e <br /> CITY OF ORONO * 2 0 1 6 — 0 0 3 8 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 04/18/2016 <br /> ORONO, MN 55356— <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1185 FERNDALE RD W <br /> PIN : 02-117-23-43-0025 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0397 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTIOI�T TYPE : FIREPLACE-GAS <br /> VALUATION : $ 4,000.00 <br /> NOTE: GAS FIREPLACE(MENDOTA FV41) <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 2.00 <br /> TWIN CITY FIREPLACE STONE CO INC MAIL-IN FEE 2.00 <br /> 6521 CECILIA CIR <br /> EDINA,MN 55439- TOTAL 54.00 <br /> (952)777-4125 Payment(s) <br /> Minnesota State License#: mech-MB682977 CHECK 20720 54.00 <br /> OWNER <br /> WYMAN,JAMES&KATHLYN <br /> 1185 FERNDALE RD W <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 /> . � ` L <br /> ,���1(��J, � k c� �Ll;�� ��L��''� '� ���_C ��Sl� ��� / � �/ ��D <br /> Applicant Permitee Signa ure Date Issued By Signature Date <br />