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' � CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 3 - 0 1 1 4 1 * <br /> DATE ISSUED: 10/25/2013 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952)249-4616 <br /> ADDRESS : 1650 SHADYWOOD RD <br /> PIN ; 17-117-23-21-0014 <br /> LEGAL DESC : SHADY-WOOD <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : MECHANICAL-MULTIPLE <br /> VALUATION : $ 7,000.00 <br /> NOTE: (1)BOILER-SLANT/FIN-MODEL LYNX95-NATURAL GAS <br /> APPLICANT MECHANICAL 87.50 <br /> COUNTRYSIDE SERVICES <br /> 6511 HWY 12 STATE SURCHARGE MECH(VALUATION) 3.50 <br /> MAPLE PLAIN,MN 55359 MAIL-IN FEE 2.00 <br /> (763)479-1600 TOTAL 93.00 <br /> OWNER <br /> KREISLER,JERROLD&BARBARA <br /> 1650 SHADYWOOD 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 sepazate <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 nuli 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due ca se. <br /> � �o� d �v� z� � � <br /> Applicant e 'ee Signa ure Date ssu By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />