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, , <br /> CITYOFORO O * z015 - 00436 * <br /> 2750 KELLEY PA WAY DATE ISSUED: OS/26/2015 <br /> ORONO, MN 553 6- <br /> 952 249-4600 FAX: 95 249-4616 <br /> ADDRESS : 4360 BAYSIDE RD <br /> PIN : 06-117-23-12-0001 <br /> LEGAL DESC : UNPLATTED 06 117 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : MECHANICAL-MULTIPLE <br /> VALUATION : $ 17,000.00 <br /> NOTE: GEOTHERMAL-2 HEATING SYSTEMS, 1 COOLING SYSTEM <br /> APPLICANT MECHAN CAL 212.50 <br /> STATE S RCHARGE MECH(VALUATION) 8.50 <br /> UMR GEOTHERMAL MAIL-IN EE 2.00 <br /> 5115 INDUSTRIAL STREET <br /> MAPLE PLAIN,MN 55359 TOTAL 223.00 <br /> (763)479-6325 Payment( ) <br /> Minnesota State License#:mech-MB003275 CHECK 035597 223.00 <br /> OWNER <br /> MAJOR,LYDIA&CHRIS <br /> 4360 BAYSIDE RD <br /> MAPLE PLAIN,MN 55359- <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 fo�due cause. <br /> �J ,t��4 /N <br /> Applicant Permitee Signature Date ssu B Signature Date <br />