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, � ' CITY OF ORONO * z 0 1 z — 0 1 1 3 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 1U08/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2735 COUNTRYSIDE DR W <br /> PIN : 04-117-23-12-0018 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 003 BLOCK 003 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DUCT WORK <br /> VALUATION : $ 1,000.00 <br /> NO"fE: (I)K[7'CHEN F,XHt1UST-DUC"C 300 CFM AND GASLINE POR KITCHEN RANGE <br /> � <br /> � <br /> APPLICANT MECHAN[CAL 50.00 <br /> SAYLOR HEATING&AC STATE SURCHARGE MECH (VALUATION) 0.50 <br /> 6800 WEST LAKE ST. <br /> ST. LOUIS PARK, MN 55426- MAIL-IN FEE 2.00 <br /> (6l2)702-6622 TOTAL 52.50 <br /> PA[D WITH CC# 3833 <br /> OWNER <br /> ALEXANDER, TIM <br /> 2735 COUNTRYSIDE DR W <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORN STATEMENT <br /> Thc 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."Chis permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within l80 days of the date of issuanee,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[3uilding Code.This permit may be <br /> revoke�any time for due ca�se. <br /> /l / �' / /o�-- // / / �-- <br /> Applicant Permitce Signature Date [ssu By Signature Datc <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />