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t <br /> � CITY OF ORONO PERMIT NO.: 2010-00245 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 04/20/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 4250 FOREST LAKE DR <br /> PIN : 07-117-23-12-0022 <br /> LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN <br /> : LOT 000 BLOCK 002 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTIOIV TYPE : HEATING SYSTEMS <br /> VALUATION : $ 4,000.00 <br /> NOTE: 1 RUUD NATURAL GAS FURNACE <br /> APPLICANT MECHAN[CAL 50.00 <br /> RON'S MECHANICAL, INC. STATE SURCHARGE MECH (VALUATION) 2.00 <br /> 12010 OLD BRICK YARD ROAD <br /> SHAKOPEE, MN 55379 MA[L-IN FEE 2.00 <br /> (952)445-8585 MISC FEE 0.00 <br /> TOTAL 54.00 <br /> OWNER <br /> ETAL, ROBERT DONGOSKE <br /> 4250 FOREST LAKE DR <br /> MOUND, MN 55364 <br /> AGREEMENT AND SWORN STATEMENT <br /> I he work for which this permit is issued shall be performed according to <br /> thc 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 ofwork <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 f'or a period of 180 days at any time afrer work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with the S[ate Building Code.This permit may be <br /> revoked at any time for due cause. <br /> ��y�'��l. �- l l �//''t�--y( l l <br /> Applicant Permitee Signature Date Issued By gnature ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO . <br />