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r A <br /> CITY OF ORONO * 2 0 1 3 — 0 PJ 7 3 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/30/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2670 COUNTRYSIDE DR W <br /> PIN : 04-117-23-12-0013 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 005 BLOCK 002 <br /> PERMIT TYPE : MECHANICAL(> $500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : MECHANICAL- MULT�IPLE <br /> VALUATION : $ 9,500.00 <br /> �o�n:: �i� i.F�Nox F��1RNnci�n�vi�nic <br /> APPLICANT MECHANICAL 1 18.75 <br /> GOLDEN VALLEY HEATING& AIR STATE SURCHARGE MECH (VALUATION) 4.75 <br /> 5182 WEST BROADWAY <br /> CRYSTAL, MN 55429- MAIL-IN FEE 2.00 <br /> (612) 535-2000 TOTAL 125.50 <br /> PAID WITH CC# 7420 <br /> OWNER <br /> DEVERE, ROBERT&JEAN <br /> 2670 COUNTRYSIDE DR W <br /> LONG LAKE, MN 55356 <br /> AGREEMENT AND SWORN STATEMENT <br /> 1-he work for which this permit is issucd shall be performed according to <br /> [he approved plans and specitications,applicable City approvals,and the <br /> State Building Code. "I�his 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 wilh whether or not specitied 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 E3uilding Code.'I�his permit may be <br /> revoked at any time for due ca�se. <br /> C 7� �� /3 y� � ,�3 <br /> Applicant Permitee Signature Date Issu� By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />