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S 'm <br /> iiiiiiiiiiiiiiiiiiiiiolitillillillillilI <br /> CITY OF ORONO * 2017 - 008S8 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/24/2017 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)2494616 <br /> ADDRESS : 4753 NORTH SHORE DR <br /> PIN : 07-117-23-32-0020 <br /> LEGAL DESC : BERGQUIST&WICKLUNDS PARK <br /> LOT 004 BLOCK 006 <br /> PERMIT TYPE MECHANICAL <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE : COOLING SYSTEMS <br /> VALUATION : $ 5,400.00 <br /> NOTE: 1 AMANA COOLING SYSTEM <br /> APPLICANT MECHANICAL 67.50 <br /> BLUE OX HEATING&AIR STATE SURCHARGE MECH(VALUATION) 2.70 <br /> 5720 INTERNATIONAL PKWY MAIL-IN FEE 2.00 <br /> NEW HOPE,MN 55428- TOTAL 72.20 <br /> (612)238-9709 Payment(s) <br /> Minnesota State License#:mech-MB671957 CHECK 12483 72.20 <br /> OWNER <br /> CORNELISSEN,THOMAS <br /> 4753 NORTH SHORE DR <br /> MOUND,MN 55364- <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 /> L�Sv 71AL11 /7 <br /> Applicant Permitee Signature Date Issued By4lignature Date <br />