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CITY OF ORONO * Z 0 1 7 - 0 0 5 5 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OS/30/2017 <br /> . ` ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1205 SHORELINE DR <br /> PIN : 02-117-23-43-0015 <br /> LEGAL DESC : REG. LAND SURVEY NO.0397 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : COOLING SYSTEMS <br /> VALUATION : $ 2,895.00 <br /> NOTE: ALL TEST[NG REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> REPLACE:COOL[NG SYSTEM(DA[KEN) <br /> APPLICANT MECHANICAL 50.00 <br /> AIRICS HEATNG STATE SURCHARGE MECH(VALUATION) 1.45 <br /> 4905 HWY 13 W MAIL-IN FEE 2.00 <br /> SAVAGE, MN 55377- TOTAL 53.45 <br /> (952)345-0032 Payment(s) <br /> Minnesota State License#: mech-MB004088 CHECK 16769 53.45 <br /> OWNER <br /> JACKLEY,JAY&MARY <br /> 1205 SHORELINE DR <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 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 l80 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 /> C � � � ��L �Z i./ l GC.��l� <br /> Applicant Permitee Signature Date Issued B Signature Date <br />