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111 11111111111 1111111111111111111111 <br /> CITY OF ORONO <br /> * 20 1 7 - 0 P1 6 7 1 <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/20/2017 <br /> ORONO,MN 55356- <br /> • <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 85 WEAR LA N <br /> PIN : 33-118-23-34-0005 <br /> LEGAL DESC : ROLLING MEADOWS 2ND ADDN <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : COOLING SYSTEMS <br /> VALUATION : $ 5,200.00 <br /> NOTE: (1)DAIKIN COOLING SYSTEM-4 TONS <br /> APPLICANT MECHANICAL 65.00 <br /> STATE SURCHARGE MECH(VALUATION) 2.60 <br /> CENTERPOINT ENERGY MAIL-IN FEE 2.00 <br /> 6161 GOLDEN VALLEY RD <br /> BUILDING A TOTAL 69.60 <br /> GOLDEN VALLEY,MN 55422- Payment(s) <br /> (763)512-2765 CHECK 21009 69.60 <br /> Minnesota State License#:mech-MB003503 <br /> OWNER <br /> SIEVERT, MICHEAL&GAYLE <br /> 85 WEAR LA N <br /> LONG LAKE,MN 55356 <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 /> ROa- 'e ct, / D 1 I7 <br /> Applicant Permitee Signature Date Issued BS gnature Date <br />