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,. CITY OF ORONO * z 0 1 z - 0 0 3 7 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OS/07/2012 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2650 COUNTRYSIDE DR W <br /> PIN : 04-117-23-12-0014 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 006 BLOCK 002 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : COOLING SYSTEMS <br /> VALUATION : $ 4,600.00 <br /> NOTE: 1 CARRIER 4 TON AC <br /> APPLICANT MECHANICAL 57.50 <br /> CENTER POINT ENERGY MINNEGASCO STATE SURCHARGE MECH (VALUATION) 230 <br /> 9320 EVERGREEN BLVD NW <br /> SUITE B MAIL-IN FEE 2.00 <br /> COON RAPIDS, MN 55433 MISC FEE 0.00 <br /> (763)757-6202 TOTAL 61.80 <br /> OWNER <br /> JORGENSON, ROBERT <br /> 2650 COUNTRYSIDE DR W <br /> LONG LAKE, MN 55356 <br /> AGREEMEIYT AND SWORIV STATEMENT <br /> I'he work for which this permit is issued shall be performed according to <br /> thc approved plans and specifications,applicable City approvals,and the <br /> State[3uilding Code. This permit is for only the work described and does <br /> not grant permission for addi[ional or related work which requires separate <br /> permi[s. All provisions of laws and ordinances goveming this type of work <br /> shall be compied with whether or not specitied herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within I 80 days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any[ime 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 /> ` I'►'��'� �' / / / / <br /> Applicant Permitee Signature Date Issued By nature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A VE. <br />