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4 CITY OF ORONO * Z 0 1 6 - 0 1 S 4 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 12/15/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 560 SUSSEX CIR <br /> PIN : 04-117-23-32-0020 <br /> LEGAL DESC : FOX BEND <br /> : LOT 003 BLOCK 002 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : HEATING SYSTEMS <br /> VALUATION : $ 2,500.00 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> (1)DAIKIN NATURAL GAS FURNACE <br /> APPLICANT MECHANICAL 50.00 <br /> CENTERPOINT ENERGY STATE SURCHARGE MECH(VALUATION) 1.25 <br /> 6161 GOLDEN VALLEY RD MAIL-IN FEE 2.00 <br /> BUILDING A TOTAL 53.25 <br /> GOLDEN VALLEY, MN 55422- Payment(s) <br /> (763)512-2765 CHECK 20709 53.25 <br /> Minnesota State License#:mech-M6003503 <br /> OWNER <br /> WHITMAS,JAMES& RENATE <br /> 560 SUSSEX CIR <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which Ihis 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 /> d �. �� � ► 1- I <br /> ��.�.t� i /Si � <br /> Applicant Permitee Signature Date Issued B ignature Date <br />