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� �-� CITY OF ORONO * 2 0 1 7 - 0 0 0 2 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OU1U2017 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952 249-4616 <br /> ADDR S� : 3115 SUSSEX RD <br /> PIN : 04-117-23-32-0015 <br /> LEGA I�ES : FOX BEND <br /> : LOT 004 BLOCK 002 <br /> PERMI TY : MECHANICAL <br /> PROPE TY YPE : RESIDENTIAL <br /> CONS UC ON TYPE : VENTILATION <br /> VALU IO : $ 450.00 <br /> NOTE: LL T TING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> (1)BAT EXH ST<300 CFM <br /> RELOC �T SUPPLIES <br /> APPLICANT MECHANICAL 50.00 <br /> PRACTI t�L STEMS STATE SURCHARGE MECH(VALUATION) 0.23 <br /> 4342B S D AK RD MAIL-IN FEE 2.00 <br /> HOPK S, 5343 TOTAL 52.23 <br /> (952)93 1868 Payment(s) <br /> CREDIT CARD 5815 52.23 <br /> ' OWNER <br /> MARY �K ,DANIEL DELMORE& <br /> 3115 SU S�X <br /> LONG L I�E, 55356- <br /> A R1EE ENT AND SWORN STATEMENT <br /> The work r whic is permit is issued shall be performed according to <br /> the approv d plans d specifications,applicable Ciry approvals,and the <br /> State Build n�C This permit is for only the work described and dces <br /> not grant rntissi for additional or related work which requires separate <br /> permits. A I provi ' ns of laws and ordinances goveming this type of work <br /> shall be co p�ed ' whether or not specified herein.This permit will <br /> expire and Come II and void if construction authorized is not <br /> commenc �ithin 80 days of the date of issuance,or if construction is <br /> suspended or�a pe ' of 180 days at any time after work has commenced. <br /> The applic t's re nsible for assuring all required inspections are <br /> requested i cbnfo ance with the State Building Code.This permit may be <br /> revoked at }+tim or due cause. <br /> �1� / / /� / �� <br /> Applicant rmi Signature Date Issued Signature Date <br />