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� + CITY OF ORONO * 2 0 1 3 - 0 0 9 6 8 * 2750 KELLEY PARKWAY DATE ISSUED: 09/17/2013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3020 SOMERSET LA PIN : 04-117-23-23-0031 LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN : LOT 000 BLOCK 004 PERMIT TYPE : MECHANICAL(>$500) PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : MECHANICAL-MULTIPLE VALUATION : $ 9,200.00 NO'I'E: (1)LENNOX FURNACE AND A/C f�URNACE- 1 10,000 INPUT BTU'S- 105,600 OUTPUT BTU'S A/C-4 TONS APPLICANT MECHANICAL 115.00 GOLDEN VALLEY HEATING&AIR STATE SURCHARGE MECH(VALUATION) 4.60 5182 WEST BROADWAY CRYSTAL, MN 55429- MAIL-IN FEE 2.00 (612)535-2000 TOTAL 121.60 PAID WITH CC# 7420 OWNER HARE,ROBERT&BENTE 3020 SOMERSET LA LONG LAKE, MN 55356- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the Sta[e Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances goveming this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. �� _ � li i� i l� �i�Y�,z��ti �i i�i i�� Applicant Permitee Signature Date � Issue By Si�nature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.