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CITY OF ORONO 1111111111 11.111„.1,111.1,1 I II <br /> * 20 1 4 - 0 1 4 5 2 <br /> 2750 KELLEY PARKWAY DATE ISSUED: 12/22/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 450 OLD LONG LAKE RD <br /> PIN ; 36-118-23-34-0014 <br /> LEGAL DESC : SUMMIT STATION <br /> LOT 007 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : HEATING SYSTEMS <br /> VALUATION : $ 3,900.00 <br /> NOTE: CARRIER HEATING SYSTEM <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 1.95 <br /> CENTER POINT ENERGY MINNEGASCO MAIL-IN FEE 2.00 <br /> 9320 EVERGREEN BLVD NW TOTAL 53.95 <br /> SUITE B <br /> COON RAPIDS, MN 55433 Payment(s) <br /> (763)757-6202 CHECK 109099 53.95 <br /> Minnesota State License#: mech-003503 <br /> OWNER <br /> POLICINSKI,CHRISTOPHER&ANNE <br /> 450 OLD LONG LAKE RD <br /> WAYZATA,MN 55391- <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 goveming 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. v/2 <br /> Mail 11-0i /- kcm6 / 7 , 2 � / V <br /> Applicant Permitee Sign ture Date Issued By Signa rtkt a Date <br />