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CITY OF ORONO * 2 0 1 4 - 0 0 1 z e * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 02/12/2014 <br /> ' ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952 249-4616 <br /> ADDRESS : 2775 COUNTRYSIDE DR W <br /> PIN : 04-117-23-12-0016 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 001 BLOCK 003 <br /> PERMIT TYPE : MECHANICAL(> $500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : MECHANICAL- MULTIPLE <br /> VALUATION : $ 9,000.00 <br /> NOTF.: 1 GOODMAN NAT GAS HEA7�[NG SYSTEM <br /> 1 GOODMAN 1.5 TON AC <br /> APPLICANT MECHANICAL ll2.50 <br /> STATE SURCHARGE MECH (VALUATION) 4.50 <br /> RIGHTMARK LLC <br /> P.O. BOX 343 TOTAL 117.00 <br /> BUFFALO, MN 55313- Payment(s) <br /> CREDIT CARD 4704 117.00 <br /> OWNER <br /> MURLEY,TODD& MARY <br /> 2755 COUNTRYSIDE DR W <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permil is issued shall be performed according to <br /> [he approved plans and specitications,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 la�vs 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 wi[h the State E3uilding Code.This pennit may be <br /> revoked at any time for due cause. <br /> �1 / / <br /> Applicant Permitee Signature Date Issued By Si ature ,�/� Date <br /> G�C:+ 1� � <br />