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, • <br /> CITY OF ORONO PEaM�T No.: 2oii-ois33 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 12/09/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> AUDRESS : 2555 COUNTRYSIDE DR <br /> PIN : 04-117-23-14-0006 <br /> LEGAL DESC : COUNTRYSIDE MANOR <br /> : LOT 004 BLOCK 002 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : MECHAN[CAL-MULTIPLE <br /> VALUATION : $ 3,000.00 <br /> NOTE: (1)RUDD IIEATING SYSTEM <br /> MODEL-RGRL-09GZAJS <br /> NATURAL GAS <br /> 90,0001NPUT <br /> 72,000 OUTPU"C <br /> APPLICANT MECHANICAL 50.00 <br /> PRACTICAL SYSTEMS STATE SURCHARGE MECH (VALUATION) 1.50 <br /> 4342 B SHADY OAK RD <br /> HOPKINS, MN 55343 TOTAL 51.50 <br /> (952)933-1868 <br /> OWivER <br /> SCHNEBLY, MR.& MRS. <br /> 2555 COLTNTRYSIDE DR <br /> LONG C,AKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be perfonned 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 pennission 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 specitied 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 reyuired inspections are <br /> requested in conformance wilh the State[3uilding Code.This permit may be <br /> revoke,�1 at any time r due cause. <br /> ' � I � �� �-� /� <br /> Applicant Permitee ignature Date Issue y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />