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_ CITY OF ORONO * 2 0 1 3 - 0 1 3 0 7 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 12/19/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3215 CRYSTAL BAY RD <br /> PIN : 17-117-23-41-0010 <br /> LEGAL DESC : TOWNSITE OF LANGDON PARK <br /> : LOT 001 BLOCK 002 <br /> PERMIT TYPE : MECHANICAL(> $500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTTON TYPE : HEATING SYSTEMS <br /> VALUATION : $ 3,300.00 <br /> NO"1'I?: 1 CARRIGR NAT GAS FURNACE <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH (VALUATION) 1.65 <br /> CENTER POINT ENERGY MINNEGASCO MAIL-IN FEE 2.00 <br /> 9320 EVERGREEN BLVD NW <br /> SUITE B TOTAL 53.65 <br /> COON RAPIDS, MN 55433 Payment(s) <br /> (763)757-6202 CHECK ]8046 53.65 <br /> OWNER <br /> PRUETER, MARK <br /> 3215 CRYSTAL BAY RD <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall bc performed according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> S[ate Building Code. This pemiit is fbr only the work described and does <br /> not gran[permission for additional or related work which requires separate <br /> permi[s. All provisions of laws and ordinances goveming 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 no[ <br /> commenced widiin 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 E3uilding Code.This permit may be <br /> revoked at any time for due cause. <br /> c <br /> \i�1'1.��( � / / <br /> Applicant Permitee Signature Date Issued E3y S' ature Date <br />