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CITY OF ORONO ®� <br /> * 2 0 1 4 - 0 0 3 1 2 <br /> 2750 KELLEY PARKWAY DATE ISSUED: 04/15/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS 4440 FOREST LAKE LANDING <br /> PIN 07-117-23-24-0017 <br /> LEGAL DESC TONKAVIEW GARDENS <br /> LOT 012 BLOCK 000 <br /> PERMIT TYPE MECHANICAL(> $500) <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE MECHANICAL-MULTIPLE <br /> VALUATION $ 8,600.00 <br /> NOTE: VENTILATION FOR(2)BATH EXHAUST AND GASLINE FOR COOKTOP <br /> APPLICANT MECHANICAL 107.50 <br /> STATE SURCHARGE MECH (VALUATION) 4.30 <br /> COUNTRYSIDE HEATING & COOLING TOTAL 111.80 <br /> 6511 HWY 12 <br /> MAPLE PLAIN, MN 55359 Payment(s) <br /> CHECK 1 111.80 <br /> (763)479-1600 <br /> OWNER <br /> CHURCH,JOSEPH <br /> 6175 STONE COURT <br /> INDEPENDENCE, MN 55359- <br /> AGREEMENT AND SWORN STATEMENT <br /> The 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.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 with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> 7 <br /> i 69i l <br /> A licant Permitee Signature Date IssudA By Signature Date <br />