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CITY OF ORONO PERMIT NO.: 2011-00340 <br /> , 2750 KELLEY PARKWAY <br /> " ORONO, MN 55356- �ATE [SSUEu: OS/13/2011 <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1991 FAGERNESS POINT RD <br /> PIN : 18-117-23-41-0001 <br /> LEGAL DESC : FAGERNESS <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCTION TYPE : MECHANICAL- MULTIPLE <br /> VALUAT[ON : $ 11,837.00 <br /> NOTL': 2 LL'NNOX HEATING SYSTEMS <br /> APPLICANT MECHANICAL 147.96 <br /> SEDGWICK HEATING &A/C STATE SURCHARGE MECH (VALUATION) 5.92 <br /> 1408 NORTHLAND DR- SUITE 310 <br /> MENDOTA HEIGHTS, MN SS l 18- MAIL-[N FEE 2.00 <br /> (952) 881-9000 TOTAL 155.88 <br /> OWNER <br /> MILLIREN, GUY& SALLY <br /> 1991 FAGERNESS PT RD <br /> WAYZATA, MN 55391 <br /> AGREEMENT AND SWORN STATEMENT <br /> � The work for which this permit is issued shall be perfonned according to <br /> the approved plans and specifieations,applicable City approvals,and the <br /> S[ate Building Codc. 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 consuuction authorized is not <br /> commenced within]80 days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time aiter work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with the State Building Code.This pennit may be <br /> revoked at any time for due caase. <br /> ` <br /> \�—p�"�, �� / / / / <br /> Applicant Permitee Signature Date Issued Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO . <br />